Dental appliance with repositioning jaw elements

ABSTRACT

The present disclosure provides method, computing device readable medium, and devices for dental appliances with repositioning jaw elements. An example of a method can include identifying a misaligned jaw of a patient from a virtual image of the patient&#39;s jaw, and providing a treatment plan for the patient including a virtual model of a dental appliance having a first shell and a second shell configured to reposition at least one tooth of the patient. The virtual model of the dental appliance including repositioning jaw elements on the first shell and the second shell configured to move a position of the misaligned jaw of the patient.

BACKGROUND

The present disclosure is related generally to the field of dentaltreatment. More particularly, the present disclosure is related tomethods, instructions on a computing device readable medium, and deviceswith repositioning jaw elements.

Dental treatments may involve, for instance, restorative and/ororthodontic procedures. Restorative procedures may be designed toimplant a dental prosthesis (e.g., a crown, bridge, inlay, onlay,veneer, etc.) intraorally in a patient. Orthodontic procedures mayinclude repositioning misaligned teeth and changing bite configurationsfor improved cosmetic appearance and/or dental function. Orthodonticrepositioning can be accomplished, for example, by applying controlledforces to one or more teeth over a period of time.

As an example, orthodontic repositioning may be provided through adental process that uses positioning appliances for realigning teeth.Such appliances may utilize a thin shell of material having resilientproperties, referred to as an “aligner,” that generally conforms to apatient's teeth but is slightly out of alignment with a current toothconfiguration.

Placement of such an appliance over the teeth may provide controlledforces in specific locations to gradually move the teeth into a newconfiguration. Repetition of this process with successive appliances inprogressive configurations can move the teeth through a series ofintermediate arrangements to a final desired arrangement.

Such systems typically utilize materials that are light weight and/ortransparent to provide as a set of appliances that can be used seriallysuch that as the teeth move, a new appliance can be implemented tofurther move the teeth without having to take a new impression of thepatient's teeth at every increment of tooth movement in order to makethe successive appliance.

In various instances, teeth of a patient's upper jaw and teeth of thepatient's lower jaw may contact in an incorrect or suboptimal manner(e.g., crowding, crossbite, deep bite). A proper fit of the occlusalsurfaces of the teeth is necessary for proper biting and chewing, aswell as desirable for aesthetic appearance. Otherwise, premature wear ofthe teeth, undesirable flexion of the teeth, and/or undesirable forceson dental restorations may be experienced by the patient. For instance,a proper fit can be a function of the relative positions of teeth andthe mandible and maxilla, either of which may be retruded or protrudedrelative to the ideal position. The maxilla (e.g., the upper jaw) is abone that is fixed to the skull. The mandible (e.g., lower jaw) is abone that is attached to the skull by numerous muscles which guide itsmovement. The mandible articulates at its posterior upward extremitieswith the temporal bone to form the jaw joint. The jaw joint is a looselyconnected joint that accommodates the variety of movements of themandible relative to the maxilla during biting and chewing motions. Thenumerous muscles attaching the mandible to the skull control and powerthe complex movements involved in biting and chewing.

The position of the lower jaw is governed by at least two factors. Thefirst factor is the best fit or seating of the condyles of the mandiblewithin the joint housing of the temporal bone. The posterior superiormost position of the condyle in the joint is usually an ideal positionrepresenting full seating. The second factor is the best fit of theteeth between the maxilla and the mandible. Ideally, the teeth fittogether best in occlusion with the left and right jaw joint fullyseated at the same time, but this is not a requirement. Sometimes, theteeth fit together best with the condyles slightly displaced from thejoint. As a result, when the condyles are fully seated, the teeth maynot be in their best fitting position. This condition is known as ashift between the centric relationship (condyles fully seated) and thecentric occlusion (teeth best fitting).

Because the condylar relationship affords some flexibility in thepositioning of the jaw, the lower jaw can be intentionally repositionedin accordance with the best fit of the teeth, for instance, by using anorthodontic appliance. The orthodontic appliance used may or may not bedispleasing, both physically and aesthetically, to a patient undergoingtreatment which intentionally repositions the lower jaw.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A illustrates a side view of an upper jaw with a firstrepositioning jaw element and a lower jaw with a repositioning jawelement according to a number of embodiments of the present disclosure.

FIG. 1B illustrates a front view of an upper jaw with a firstrepositioning jaw element and a third repositioning jaw element and alower jaw with a second repositioning jaw element and a fourthrepositioning jaw element according to a number of embodiments of thepresent disclosure.

FIG. 1C illustrates a side view of a first shell with a firstrepositioning jaw element and a second shell with a second repositioningjaw element according to a number of embodiments of the presentdisclosure.

FIG. 2A illustrates a side view of an upper jaw with a firstrepositioning jaw element and a lower jaw with a second repositioningjaw element according to a number of embodiments of the presentdisclosure.

FIG. 2B illustrates a front view of an upper jaw with a firstrepositioning jaw element and a third repositioning jaw element and alower jaw with a second repositioning jaw element and a fourthrepositioning jaw element according to a number of embodiments of thepresent disclosure.

FIG. 3 illustrates an example of a method for separating an upperdentition from a lower dentition according to a number of embodiments ofthe present disclosure.

FIGS. 4A-4C illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure.

FIGS. 5A-5C illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure.

FIG. 6 illustrates an example computing device readable medium havingexecutable instructions that can be executed by a processor to perform amethod according to one or more embodiments of the present disclosure.

FIGS. 7A-7D illustrate examples of a plurality of devices forrepositioning jaws according to a number of embodiments of the presentdisclosure.

FIGS. 8A-8D illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure.

FIGS. 9A-9B illustrate examples of features of devices for repositioningjaws according to a number of embodiments of the present disclosure.

FIGS. 10A-10C illustrate examples of occlusal features of devices forrepositioning jaws according to a number of embodiments of the presentdisclosure.

FIGS. 11A-11B illustrate examples of devices for repositioning jawsaccording to a number of embodiments of the present disclosure.

FIGS. 12A-12B illustrate examples of devices according to a number ofembodiments of the present disclosure.

FIGS. 12C-12D illustrate examples of repositioning jaw elementsaccording to a number of embodiments of the present disclosure.

FIGS. 13A-13B illustrate examples of side surface features according toa number of embodiments of the present disclosure.

FIGS. 14A-14B illustrate examples of repositioning jaw elements foradjusting a midline of a patient according to a number of embodiments ofthe present disclosure.

DETAILED DESCRIPTION

As discussed above, the present disclosure provides methods,instructions on computing device readable medium, and devices forrepositioning jaw elements. Generally, the repositioning occurs duringan orthodontic treatment which is a process of moving and reorientingteeth for functional and/or aesthetic purposes, although repositioningmay be made for other purposes.

Simultaneous contacting of the upper and lower teeth on the right andleft sides, and in the anterior and posterior occlusal areas withmaximum interdigitation is desired for proper positioning of the lowerjaw to the upper jaw in the mouth of a patient. An unbalanced occlusion,such as a malocclusion, is disruptive to the proper biting and chewingfunctions because excessive forces may be placed in a particular areathat can lead to premature wear and/or restoration failure, or becauseundesirable forces such as flexion may lead to stresses which causeabfraction lesions and/or crowding/spacing of the teeth. The position ofa patient's jaw can be changed, for instance, using an orthodonticappliance (e.g., a dental appliance).

Current approaches for jaw repositioning, such as those performed priorto fixed orthodontic treatment (i.e., “braces”) include having atreatment professional place an orthodontic appliance which may includeblock elements, wires, tensioning springs, horizontal stops, etc., whichis firmly fixed to the teeth and which applies repositioning forces tomove the jaw of the patient, thereby causing the relative positioning ofthe patient's upper and lower jaws to adjust. Some believe that thisrepositioning stimulates jaw growth in patients with growth potentialremaining, while others believe that the muscles can re-learn a newposition so long as the teeth are made to fit together well in the newjaw position. In some instances, prior approaches include a removableappliance with block elements.

Current appliances for jaw repositioning are not designed to repositionthe teeth during the process of jaw repositioning. After adjustment ofthe position of the patient's jaw, further orthodontic treatment isperformed to move and re-orientate the teeth of the patient for improveddental interdigitation, if necessary. Many of the current jawrepositioning devices can be displeasing to patients, both physicallyand aesthetically, because the patient does not have the option toremove the appliance even for a short period of time. Such appliances(e.g., Herbst appliance) are typically cemented into place on thepatient's teeth. Depending on whether the jaw change is due to growth ormuscular repositioning, realigning the teeth of a patient afterrepositioning the jaw can result in reversion of the position of the jawif the teeth are not positioned and/or repositioned in a manner thatbest supports the new jaw position. This would occur, for example, ifthe teeth fit better in a jaw position different from the one which isaccomplished through the jaw repositioning phase of the treatment. Inthis situation, the jaw would revert toward its original position orwhatever position is most comfortable for the patient when biting sincethe jaw repositioning appliance has been removed. Therefore, the desireis to reposition the jaw to an optimal relation while at the same timearrange the teeth such that they fit together the best both in archcoordination between the upper and lower arches and in interdigitationbetween the arches. The interdigitation makes the patient more likely tokeep the lower jaw in the new position since the teeth fit together thebest in the interdigitated position.

Repositioning a jaw (e.g., separation of occlusal surfaces and/or movingforward or backward the position of a lower jaw) according toembodiments of the present disclosure can include utilizing a set of oneor more appliances, such as positioners, retainers, and/or otherremovable appliances (e.g., clear shells and/or aligners) having a shellto be worn over the teeth of a patient and having a first repositioningjaw element thereon that is positioned to interface, interact, and/orengage a second repositioning jaw element on an appliance on an opposingjaw for separating occlusal surfaces of the patient's upper dentitionand lower dentition and/or to reposition the patient's jaw. Therepositioning jaw elements can place a force on the lower jaw of thepatient to sagittally move the lower jaw. Sagittal movement of a jaw, asused herein, can include revising a position of a lower jaw relative tothe upper jaw (e.g., in a forward or backward direction). For instance,the position of the patient's lower jaw can shift sagittally tostimulate jaw growth in patients with growth potential remaining and/orto allow muscles to re-learn a new position.

In various embodiments, the movement can be controlled to reposition thepatient's jaw in an anterior-posterior plane with respect to the jaws ofthe patient. For example, the first repositioning jaw element and thesecond repositioning jaw element can be positioned to interface as thepatient moves to a fully engaged sagittal jaw position of the patient'supper dentition and the patient's lower dentition and wherein thismovement is designed to reposition the patient's jaw in ananteroposterior plane with respect to the jaws of the patient.

For example, one or more embodiments can include providing a virtualmodel of a dental appliance having a shell configured to reposition anumber of teeth of a patient. The virtual model of the dental appliancecan, for instance, be created from a virtual model of the jaw of thepatient and/or from a physical mold of the jaw of the patient. A virtualrepositioning jaw element can, for example, be positioned on the shellof the virtual model of the dental appliance parallel to a bite plane ofthe patient and/or can extend from a surface of the shell of the virtualmodel of the dental appliance. The positioning of the virtualrepositioning jaw element and/or the design of the virtual repositioningjaw element can be based on and/or included in a treatment plan. Forinstance, the treatment plan can include a desired and/or final jawposition. The virtual model of the dental appliance with the revisedposition of the repositioning jaw element can be used to create aphysical dental appliance, for instance, as discussed further herein.

A dental appliance, in accordance with some embodiments of the presentdisclosure, can include a first shell having a number of tooth aperturesconfigured to receive and reposition a number of teeth of a patient'supper dentition and a second shell having a number of tooth aperturesconfigured to receive and reposition a number of teeth of the patient'slower dentition. Each shell (e.g., the first shell and second shell) canhave a repositioning jaw element extending from a surface of the shells.The repositioning jaw elements can be positioned in each respectiveshell to interact and/or interface at surfaces in the presence of afully engaged sagittal jaw position of the patient's upper jaw and thepatient's lower jaw in order to reposition the patient's jaw and/orseparate occlusal surfaces of the patient's teeth for treatmentpurposes. A fully engaged sagittal jaw position, as used herein, caninclude a relationship of the mandible and the maxilla when the upperand lower jaw are closed as far as the dental appliance with therepositioning jaw elements will allow (e.g., a partial occlusal jawposition).

For example, the separation of occlusal surfaces of the patient's teethcan be used to treat sagittal malocclusions (including crossbites), deepbites, open bites, and/or other malocclusions, in various embodiments.The repositioning jaw elements can be positioned such that therepositioning jaw elements avoid interference with the shells of thedental appliance that are used to align the teeth. For instance, theseparation of occlusal surfaces can include the occlusal surfaces of atleast some of the teeth within and/or a portion of occlusal surfaces ofthe shells interacting with one or more surfaces of the repositioningjaw elements of a shell on an opposing jaw. In this manner, a dentalappliance in accordance with embodiments of the present disclosure canbe used to concurrently treat sagittal malocclusions, includingcrossbite and/or deep bite, while simultaneously repositioning a numberof teeth of the patient. Further, in some embodiments, all of this toothand jaw movement can be planned via computing device executableinstructions and therefore, excessive or redundant movements between thetwo typically separate processes can be avoided. Additionally, a virtualmodel can be created and tested so that the patient does not have to besubjected to trial and error to achieve proper jaw and teethpositioning. The ability to visualize the repositioned jaws andestablish the alignment in the repositioned configuration isadvantageous because the best alignment of the teeth when the jaw isrepositioned can be precisely established and can be different from thealignment when the jaws are not repositioned into an improved or optimalposition.

In some embodiments, a plurality of appliances can be worn by a patientsuccessively to achieve gradual simultaneous and/or sequentialrepositioning of the patient's jaw and/or gradual tooth movement. Forinstance, each of a plurality of dental appliance can reposition thepatient's jaw in incremental distances. In such embodiments, thepositions of the repositioning jaw elements can be adjusted to allow thetreatment professional to fine tune the movement of the jawsymmetrically or asymmetrically and/or to move the teeth incrementallywhich may be less painful than with fixed appliances which may impartmore sudden force in the initial period of the process than later in theprocess, among other benefits.

In the detailed description of the present disclosure, reference is madeto the accompanying drawings that form a part hereof, and in which isshown by way of illustration how one or more embodiments of thedisclosure may be practiced. These embodiments are described insufficient detail to enable those of ordinary skill in the art topractice the embodiments of this disclosure, and it is to be understoodthat other embodiments may be utilized and that process, electrical,and/or structural changes may be made without departing from the scopeof the present disclosure. As used herein, the designator “N” and “P”,particularly with respect to reference numerals in the drawings,indicates that a number of the particular feature so designated can beincluded. As used herein, “a number of” a particular thing can refer toone or more of such things (e.g., a number of teeth can refer to one ormore teeth).

The figures herein follow a numbering convention in which the firstdigit or digits correspond to the drawing figure number and theremaining digits identify an element or component in the drawing.Similar elements or components between different figures may beidentified by the use of similar digits. For example, 106 may referenceelement “06” in FIG. 1, and a similar element may be referenced as 206in FIG. 2. As will be appreciated, elements shown in the variousembodiments herein can be added, exchanged, and/or eliminated so as toprovide a number of additional embodiments of the present disclosure. Inaddition, as will be appreciated, the proportion and the relative scaleof the elements provided in the figures are intended to illustratecertain embodiments of the present disclosure, and should not be takenin a limiting sense.

FIG. 1A illustrates a side view of an upper jaw 102 with a firstrepositioning jaw element 106 and a lower jaw 104 with a secondrepositioning jaw element 108 according to a number of embodiments ofthe present disclosure. The upper jaw 102, the first repositioning jawelement 106, the lower jaw 104, and the second repositioning jaw element108 illustrated in FIG. 1A include virtual images of jaws andrepositioning jaw elements, respectively (e.g., virtual jaws and/orvirtual repositioning jaw elements), as discussed further herein. Theupper jaw 102 can include a maxilla, its related soft and hard tissues,and can include a number of teeth of a patient's upper dentition. Thelower jaw 104 can include a mandible, its related soft and hard tissues,and can include a number of teeth of the patient's lower dentition.

In some instances, the patient may exhibit abnormal occlusion ormalocclusion. For instance, this may include a jaw (or both) that isprotrusive, retrusive, or laterally displaced. As an example,positioning of the number of teeth of the patient's upper dentition andthe number of teeth of the patient's lower dentition can be such thatthe best fit of the upper dentition with the lower dentition results ina misalignment of the lower jaw 104 relative to the upper jaw 102 eitherin positional relations or at the level of the jaw joint which connectsthe lower jaw 104 to the upper jaw 102. The lower jaw 104 can be in aretruded position, for instance, resulting in a distance (e.g., space)between the front teeth of the upper dentition and the front teeth ofthe lower dentition (e.g., an increased overjet). Correction of themalocclusion can be beneficial to the patient in terms of improvedchewing ability, reduced premature wear of the teeth, and/or improvedfacial aesthetics.

In some embodiments, the upper jaw 102 and lower jaw 104 illustrated inFIG. 1A can include a virtual model of the patient's upper jaw and lowerjaw. A virtual model of one or more dental appliances (e.g., anappliance for the upper dentition and an appliance for the lowerdentition which may also be connected together) each having a shellconfigured to reposition a number of teeth of the patient can beprovided. The virtual model of the dental appliance can include avirtual model of a dental appliance configured to reposition the numberof teeth of the patient.

Repositioning jaw elements can be positioned on occlusal, buccal, and/orlingual surfaces of a dental appliance to be placed over the patient'steeth. A repositioning jaw element, as used herein, can include aportion of material (e.g., a geometric shaped element, such as a blockshape) extending from a surface of the shell of the appliance, asdiscussed further herein. For instance, a virtual repositioning jawelement can be positioned on the shell of the virtual model of thedental appliance parallel to a bite plane of the patient. A bite plane,as used herein, can include a surface from the incisal edges of theincisors and the tips of the occluding surfaces of the posterior teeththat is a mean of the curvature of the surface.

In some embodiments, the position of the virtual repositioning jawelement can be revised to align with a midline (e.g., middle) of atleast one tooth of the number of teeth wherein the virtual repositioningjaw element extends from a surface of the shell of the virtual model ofthe dental appliance. However, embodiments in accordance with thepresent disclosure are not so limited and the virtual repositioning jawelements may not be aligned with a midline of the at least one tooth invarious embodiments. The virtual model of the dental appliance,including the virtual repositioning jaw element, can be used todetermine a treatment plan for the patient and/or to form a physicaldental appliance and/or physical repositioning jaw element (e.g., asdiscussed further herein).

The physical repositioning jaw element can be formed of a variety ofmaterial types. In some embodiments, the physical repositioning jawelement can be formed of the same material as the shell of the dentalappliance (e.g., a polymeric material). For instance, the physicalrepositioning jaw element can be formed integrally with the shell and/orformed of a same material as the shell.

The repositioning jaw elements can also be positioned in differentplaces, in some embodiments. For example, the first repositioning jawelement 106 and the second repositioning jaw element 108 can bepositioned near occlusal surfaces of the teeth of the patient to advancethe placement of the lower jaw 104 in an forward direction (e.g., in ananterior direction and/or toward a patient's lips) or in a backwarddirection (e.g., in an posterior direction and/or towards the back ofthe patient's head). For instance, occlusal surfaces of teeth of theupper jaw 102 and lower jaw 104 can be separated using the firstrepositioning jaw element 106 and the second repositioning jaw element108 to move (e.g., to move sagittally) the lower jaw 104 of the patientfrom an articulation path during opening (e.g., the path that the jawcurrently follows when opening) to a desired range of jaw openingextending from an advanced or forward position of occlusion, asdescribed further herein. As an example, the first repositioning jawelement 106 can include a first surface 128 and the second repositioningjaw element 108 can include a second surface 130 to interface, interact,and/or otherwise engage with the first surface 128 of the firstrepositioning jaw element 106, as discussed further herein. By movingthe lower jaw 104, muscles associated with movement of the lower jaw 104can be retrained to a new position (generally in a forward and/ordownward direction, or in a backward direction) or the lower jaw may bepermitted to grow more fully if the patient has not fully developedskeletally.

FIG. 1B illustrates a front view of an upper jaw 102 with a firstrepositioning jaw element 106 and a third repositioning jaw element 110and a lower jaw 104 with a second repositioning jaw element 108 and afourth repositioning jaw element 112 according to a number ofembodiments of the present disclosure. A front view, as used herein, caninclude an anterior view and/or a more anterior view of the jaws ascompared to a side view. The upper jaw 102, the first repositioning jawelement 106, the third repositioning jaw element 110, the lower jaw 104,the second repositioning jaw element 108, and the fourth repositioningjaw element 112 illustrated in FIG. 1B can include virtual images ofjaws and repositioning jaw elements, respectively (e.g., virtual jawsand/or virtual repositioning jaw elements), as discussed further herein.As illustrated by FIG. 1B, two repositioning jaw elements (e.g., thefirst repositioning jaw element 106 and the third repositioning jawelement 110) can be positioned near (e.g., adjacent to) occlusalsurfaces of the upper jaw 102 and two repositioning jaw elements (e.g.,the second repositioning jaw element 108 and the fourth repositioningjaw element 112) can be positioned near occlusal surfaces of the lowerjaw 104.

The first repositioning jaw element 106 can be positioned near theocclusal surfaces of the posterior teeth (in the embodiment illustratedby FIG. 1B, the molars and/or bicuspids) of the upper jaw 102 and thesecond repositioning element 108 can be positioned near the occlusalsurfaces of the posterior teeth (in the embodiment illustrated by FIG.1B, the bicuspids) of the lower jaw 104. The first repositioning jawelement 106 and second repositioning jaw element 108 can be located neara first posterior side of the patient's dentition.

The first repositioning jaw element 106 and the second repositioning jawelement 108 can include surfaces that can interface, interact, and/orengage with a surface of a repositioning jaw element on a shell of anopposing jaw. For instance, a first surface of the first repositioningjaw element 106 can interface, interact, and/or engage with a secondsurface of the second repositioning jaw element 108. A surface, as usedherein, can include a side and/or end surface of a repositioning jawelement. In some embodiments, the first surface can include a slantedsurface on a mesial-facing surface of the first repositioning jawelement 106 and/or the second surface can include a slanted surface on adistal-facing surface of the second repositioning jaw element 108, forinstance. For example, a mesial-facing surface can include a surface ofa repositioning jaw element that is in a direction toward the anteriormidline of the teeth. A distal-facing surface can include a surface of arepositioning jaw element that is in a direction toward the last toothin each quadrant of a dental arch. However, embodiments in accordancewith the present disclosure are not so limited. A mesial-facing surface,in some embodiments, can be facing toward the facial plane (e.g., normalto the facial plane), whereas a distal-facing surface can be facing awayfrom the facial plane (e.g., normal to the facial plane but in theopposite direction). The surfaces of the repositioning jaw elements, inaccordance with embodiments of the present disclosure, can be orientedin a variety of directions.

The third repositioning jaw element 110 can be positioned near theocclusal surfaces of the posterior teeth (in embodiment illustrated byFIG. 1B, molars and/or bicuspids) of the upper jaw 102 and the fourthrepositioning jaw element 112 can be positioned near the occlusalsurfaces of the posterior teeth (in the embodiment illustrated by FIG.1B, bicuspids) of the lower jaw 104. The third repositioning jaw element110 and the fourth repositioning jaw element 112 can be located near asecond posterior side of the patient's dentition. The thirdrepositioning jaw element 110 and the fourth repositioning jaw element112 can include surfaces that can interface, interact, and/or engagewith a surface of a repositioning jaw element on an opposite jaw. Forinstance, a third surface of the third repositioning jaw element 110 caninterface, interact, and/or engage with a fourth surface of the fourthrepositioning jaw element 112. The third surface can include a slantedsurface on a mesial-facing surface of the third repositioning jawelement 110 and the fourth surface can include a slanted surface on adistal-facing surface of the fourth repositioning jaw element 112, forinstance.

However, embodiments in accordance with the present disclosure are notso limited. For instance, the surfaces of the repositioning jaw elements106, 108, 110, 112 can be oriented in a variety of directions. Forinstance, the first surface of the first repositioning jaw element 106and the third surface of the third repositioning jaw element 110 caninclude distal-facing slanted surfaces and/or the second surface of thesecond repositioning jaw element 108 and the fourth surface of thefourth repositioning jaw element 112 can include mesial-facing slantedsurfaces, among other orientations.

The surfaces (e.g., that interact and/or interface) of the repositioningjaw elements 106, 108, 110, 112 can be angled, in various embodiments,to guide the lower jaw 104 into position and gain desired lateral orprevent unwanted lateral movement. The surfaces can be angled inbuccal-lingual and/or mesial-distal direction, for example. The angle ofinteracting and/or interfacing surfaces (e.g., two surfaces that aredesigned to interface, interact, and/or engage with each other eitheractively or passively) can have the same degree and/or slant or adifferent degree and/or slant (e.g., as illustrated by the embodiment ofFIGS. 14A-14B).

For example, the first surface of the first repositioning jaw element106 and the second surface of the second repositioning jaw element 108can interface at a first slant. The slant can include, for instance, adegree of angle of the repositioning jaw elements. The third surface ofthe third repositioning jaw element 110 and the fourth surface of thefourth repositioning jaw element 112 can interface at a second slant.

The first slant and the second slant, in accordance with a number ofembodiments, can include opposing angles. The opposing angles of slantson opposing posterior sides of the patient's dentition can facilitatedesired lateral movement or limit and/or prevent unwanted lateralmovement. In some embodiments, the sum of the opposing angles caninclude 180 degrees. As an example, if the first slant is 70 degreesthen the second slant can include 110 degrees.

In accordance with some embodiments, the repositioning jaw elements 106,108, 110, 112 extending from surfaces of a shell can be used to generatedistalizing force on at least some of the teeth that are located withinthe shell. For example, when the repositioning jaw elements 106, 108,110, 112 interface, the distalizing forces can be isolated to posteriorteeth of the upper jaw. The distalizing forces can, in some embodiments,cause tooth movement of the upper jaw posterior teeth in a distaldirection. As such, the repositioning jaw elements 106, 108, 110, 112 invarious embodiments can be a substitute for Class II elastics.

In some embodiments, the repositioning jaw elements 106, 108, 110, 112can include geometric features to engage with a repositioning jawelement on an opposing jaw. Geometric features, as used herein, caninclude a variety of protruding geometric shapes (e.g., cylinder,rectangular, etc.) and/or receding geometric shapes (e.g., negativespace that matches the protruding geometric shape on a repositioning jawelement on an opposing jaw, as illustrated in the embodiment of FIG.8A). For example, a geometric feature on the first surface of the firstrepositioning jaw element 106 can include a convex cylindrical shapedfeature and a geometric feature on the second surface of the secondrepositioning jaw element 108 can include a concave cylindrical shapedfeature shaped to mate with the geometric feature on the first surfaceof the first repositioning jaw element 106.

In some embodiments, the geometric features of a first repositioning jawelement and/or a second repositioning jaw element can include aprotrusion and a socket. A socket, in various embodiments, can include aconvex geometric shape that is shaped to mate with a geometric shape onan opposing jaw (e.g., as discussed further herein). For example, afirst repositioning jaw element can include a protrusion extending fromthe first repositioning jaw element in a direction toward occlusalsurfaces of the opposing jaw. The second repositioning jaw element caninclude a socket within the second repositioning jaw element. Theprotrusion of the first repositioning jaw element can fit into thesocket of the second repositioning jaw element to assist in guiding thelower jaw into a forward position or a backward position.

Alternatively, the protrusion and/or socket can be located within and/orextend from a surface of the shell. In some instances, one or moresockets can be located within and/or extend from a surface of the firstshell located behind anterior teeth of the upper jaw. In such anembodiment, the lower incisor teeth can fit into the one or more socketsto guide the lower jaw into a forward position or backward position.

Although the present embodiments discuss guiding a jaw into a forwardposition or backward position, embodiments in accordance with thepresent disclosure are not so limited. For example, embodiments inaccordance with the present disclosure can include guiding a jaw in avariety of directions, such as a mesial-distal direction, as discussedfurther herein with regards to the embodiment illustrated in FIGS.14A-14B.

FIG. 1C illustrates a side view of a first shell 114 with a firstrepositioning jaw element 106 and a second shell 116 with a secondrepositioning jaw element 108 according to a number of embodiments ofthe present disclosure. The side view can, for instance, include aprofile view of the first shell 114 and the second shell 116. The firstshell 114 and the second shell 116, in some embodiments, can include aremovable dental appliance.

Appliances can include any positioners, retainers, and/or otherremovable dental appliances for finishing, inducing (e.g., causing smallmovements in teeth), or maintaining teeth position in connection with adental treatment. These appliances may be utilized by the treatmentprofessional in completing a treatment plan. For example, a treatmentplan can include the use of a set of dental appliances, createdaccording to models described herein.

An appliance can, for example, be fabricated from a polymeric shell,and/or formed from other material, having a number of cavities shaped(e.g. tooth apertures) to receive and apply force to reposition one ormore teeth from one geometric tooth arrangement to one or moresuccessive tooth arrangements. There may be several appliances that maybe needed to move the teeth from the beginning of a dental treatmentplan to the end of the plan. The shell may be designed to fit over anumber of, or in many instances all, teeth present in the upper and/orlower jaw. For example, a shell can have a cavity that includes a numberof tooth apertures for placement of teeth therein. Each tooth aperturecan include an interior surface (e.g., directly adjacent to the surfacesof the teeth placed therein) and an exterior surface. The interiorsurface is configured to receive and reposition a number of teeth of thepatient, for example.

The first shell 114 can include a number of tooth apertures configuredto receive and reposition a number of teeth of a patient's upperdentition. As illustrated by FIG. 1C, a first repositioning jaw element106 can extend from a surface of the first shell 114. The firstrepositioning jaw element 106 can extend from an occlusal surface of thefirst shell 114. An occlusal surface of a shell, as used herein, caninclude an exterior surface of the shell adjacent to and/or extendingtoward the occlusal surfaces of the teeth on an opposing jaw of thepatient.

The second shell 116 can include a number of tooth apertures configuredto receive and reposition a number of teeth of the patient's lowerdentition. A second repositioning jaw element 108 can extend from asurface of the second shell 116. For instance, the second repositioningjaw element 108 can extend from an occlusal surface of the second shell116.

The first repositioning jaw element 106 can include a first surface 128and the second repositioning jaw element 108 can include a secondsurface 130 to interface with the first surface 128 of the firstrepositioning jaw element 106. For example, as illustrated by theembodiment of FIG. 1C, the first repositioning jaw element 106 and thesecond repositioning jaw element 108 can be positioned to interface,interact, and/or otherwise engage in the presence of a fully engagedsagittal jaw position of the patient's upper dentition (e.g., the upperjaw 102 illustrated in FIGS. 1A-1B) and the patient's lower dentition(e.g., the lower jaw 104 illustrated in FIGS. 1A-1B) in a manner toreposition the patient's lower jaw. The reposition of the patient'slower jaw can, for instance, include moving (e.g., moving sagittally) alower jaw of the patient from an existing articulation reflex path ofopening to a desired more extended range of jaw opening whereby thelower jaw is moved forward or backward into a new sagittal jaw position.

Alternatively and/or in addition, the repositioning of the patient's jawcan include a separation of occlusal surfaces of the number of teeth ofthe patient's upper dentition from occlusal surfaces of the number ofteeth of the patient's lower dentition as the patient moves to a fullyengaged sagittal jaw position. For instance, separating occlusalsurfaces can include separating occlusal surfaces to a thresholddistance to prevent an occlusal surface of the first shell 114 fromcontacting or engaging an occlusal surface of the second shell 116. Thethreshold distance can include a particular value. For example, thethreshold distance can include one millimeter or less, among othervalues. As discussed above, the separation of occlusal surfaces caninclude the occlusal surfaces of at least some of the teeth within ashell and/or at least some of an occlusal surface of the shellcontacting or engaging with one or more surfaces of the repositioningjaw element of a shell on an opposing jaw.

In some embodiments, the separation of occlusal surfaces can be used fortreatment of sagittal malocclusion, including excess overjets andanterior crossbite, the correction of transverse malocclusions includinglateral crossbites, and/or vertical problems such as deep bite.Malocclusions can be treated using the repositioning jaw elements 106,108 (in addition to a third repositioning jaw element 110 and fourthrepositioning jaw element 112 on the opposing posterior side of the jaw,in some embodiments, as illustrated by the embodiment of FIG. 1B) toreposition the jaw of the patient. In some situations, such as anteriorcrossbite and deep bite can be treated using the repositioning jawelements 106, 108 to allow for individual movement of teeth while thejaws are repositioned into a new relative relationship.

Patients with crossbites and/or deep bites can have anterior incisors inthe upper jaw and/or the lower jaw that are difficult to move into thedesired location because teeth in the opposing jaw are a physicalobstruction and therefore can prevent the desired movement from takingplace, in some instances. The repositioning jaw elements 106, 108 canprovide separation of the upper jaw from the lower jaw (e.g.,disclusion) by separating an occlusal surface of the first shell 114from an occlusal surface of the second shell 116. In various instances,the repositioning jaw elements 106, 108 used for the treatment ofcrossbites and deep bites can be the same buccal-lingual length and canextend from an occlusal, lingual, and/or buccal surface of the firstshell 114 and the second shell 116.

The repositioning jaw element 106, 108 can be positioned near posteriorteeth, for instance, to allow for an anterior portion of the bite of thepatient to open enough (e.g., disengage the occlusal interferences thatmay normally take place) to allow for easier treatment of the crossbiteand/or deep bite. For instance, the separation of occlusal surfaces canbe caused by preventing the cusp of the molars from sliding back intothe fossae on the opposing molars. In such situations, the upper jaw andthe lower jaw are held apart and avoid interfering with the prescribedtreatment, for example.

In accordance with a number of embodiments of the present disclosure, anopening of 5-6 millimeter (mm) at the first premolar region can bedesirable for treatment of deep bite, open bite, and/or othermalocclusions. For example, an aim of repositioning jaw elements totreat a patient with Class II, Division I deep bite can be to cause a 2mm inter-incisal clearance (e.g., space between the incisal teeth of theupper jaw and incisal teeth of the lower jaw) resulting in a 5-6 mmopening at the first premolar region (e.g., teeth). By contrast, an aimof repositioning jaw elements to treat a patient with Class II, DivisionII deep bite can be to cause 0 mm of inter-incisal clearance (e.g.,portions of the dental appliance with incisal teeth therein contact)resulting in a 5-6 mm opening at the first premolar region. Further, anaim of repositioning jaw elements to treat a patient with Class II, openbite can be to increase the inter-incisal clearance, as compared torepositioning jaw elements for Class II, Division 1 deep bite, resultingin a 5-6 mm opening at the premolar region. For example, in a 2 mmanterior open bite patient, a 4 mm inter-incisal clearance can beoptimal. In various embodiments, the repositioning jaw element 106, 108can inherently cause disclusion of posterior teeth of the patient.

The repositioning jaw elements 106, 108 interfacing, interacting, and/orengaging can be used to reposition a patient's lower jaw (e.g., lowerjaw 112 illustrated in the embodiment of FIG. 1A-1B) by placing a forceon the patient's jaw. The force can include a force on the jaws ofpatient for sagittal correction. The force can, for instance, sagittallymove the patient's lower jaw (e.g., in an anterior or posteriordirection) to reposition the patient's jaw.

In some embodiments, repositioning jaw elements, such as the firstrepositioning jaw element 106 and second repositioning jaw element 108,can include occlusal surfaces of the repositioning jaw elements thatsubstantially follow the contours of the occlusal surfaces of teeth onan opposing jaw of the patient (e.g., as illustrated in the embodimentof FIG. 12B). For instance, the occlusal surface (e.g., the top surface)of the first repositioning jaw element 106 can substantially follow thecontours of the occlusal surfaces of the posterior teeth of the lowerjaw (e.g., the occlusal surfaces of the posterior teeth of the lower jawthat the first repositioning jaw element 106 may contact). The occlusalsurface of the second repositioning jaw element 108 can substantiallyfollow the contours of the occlusal surfaces of the posterior teeth ofthe upper jaw (e.g., the occlusal surfaces of posterior teeth of theupper jaw that the second repositioning jaw element 108 may contact).Shaping the occlusal surfaces of repositioning jaw elements based on thepatient's dentition may, for instance, avoid interference between cuspsof teeth that may otherwise hit interferences in an opposing jaw whichcould increase the likelihood of unwanted tooth and/or jaw movements.

Alternatively and/or in addition, in some embodiments, occlusal surfacesof the repositioning jaw elements and/or other occlusal surfaces of theremovable dental appliance can have a geometry that differs from thecontours of the occlusal surfaces of teeth that are of an opposing jawof the patient (e.g., as illustrated in the embodiment of FIG. 10C). Forinstance, the geometry can include a pattern to match a new jaw position(e.g., forward or backward lower jaw position) of the patient (e.g., asdiscussed further herein).

In accordance with some embodiments of the present disclosure, aremovable dental appliance can include the first shell 114 and secondshell 116. The removable dental appliance can be configured toreposition a number of teeth of the patient's upper dentition and anumber of teeth of the patient's lower dentition concurrently withrepositioning of the patient's jaw. The simultaneous treatment ofmisalignment of a patient's jaw (e.g., Class II correction) inconjunction with teeth alignment issues (e.g., rotation, tipping, etc.)can shorten treatments times compared to sequential treatment protocolsthat first treat the misalignment of a patient's jaw before treating themisalignment of the patient's teeth. To help accomplish this objective,the repositioning jaw elements 106, 108, in accordance with a number ofembodiments, avoid and/or do not interfere with the engagement of theshell with the teeth contained therein.

The simultaneous treatment of misalignment of a patient's jawconcurrently with teeth misalignment can assist in the treatment ofrepositioning the patient's jaw. If untreated, teeth misalignment mayencourage occlusion in the original jaw position instead of the desiredjaw position (e.g., the intended or final jaw position), since theoptimal interdigitation between the arches coincides with the originaljaw position. Realignment of the teeth so that the teeth fit togetherbest in the desired jaw position can reinforce the desired jaw positionwhen the appliances are removed. Repositioning of the patient's jaw caninclude retraining the muscles associated with the movement of the lowerjaw. Due to the misalignment of a patient's teeth, a lower jaw of thepatient can be incorrectly positioned in a retruded position because theteeth position with the best fit may force the jaw into a more retrudedposition than physiologically comfortable. A treatment whereby the teethfit better in an anteriorly positioned mandible can relieve the jointcompression that may take place when the mandible is retruded. The jawmuscles of the patient can be retrained to hold the lower jaw in a moreforward (and more comfortable) position.

In contrast, the removable dental appliance embodiments discussed hereincan comprise a first shell 114, a second shell 116, a firstrepositioning jaw element 106 extending from a surface of the firstshell 114, and a second repositioning jaw element 108 extending from asurface of the second shell 116 and can concurrently treat misalignmentof the patient's jaw and misalignment of the patient's teeth. Concurrenttreatment can avoid and/or prevent reversion and/or retraining of themuscles in an incorrect position, among other benefits. Further,removable dental appliance embodiments, in accordance with the presentdisclosure, can result in fewer braces and/or elastics as compared toprior solutions. In growing patients, the concurrent treatment may alsoencourage growth of the jaw(s) in a more favorable direction.

Although the present embodiment of FIGS. 1A-1C illustrates repositioningjaw elements extending from an occlusal surface of a shell and/or nearan occlusal surface of one or more teeth of a patient, embodiments arenot so limited. The repositioning jaw elements, in some embodiments, canextend from a buccal surface, a lingual surface, an occlusal surface,and/or a combination thereof.

In some embodiments, the repositioning jaw elements (e.g., firstrepositioning jaw element 106 and second repositioning jaw element 108illustrated in FIG. 1C) can be hollow and/or can be filed with amaterial, such as a tooth colored material, a clear material, anacrylic, and/or a composite, among other materials, including materialsthat are printed via a three-dimensional (3D) printer or a through astereolithography process. The extra material can, for instance, provideadditional compressive strength as compared to a hollow repositioningjaw element.

In some embodiments, the hollow space within the repositioning jawelement can be used as a reservoir for the disbursement of medicationsor other items within the patient's mouth. For example, breathfreshening agents, medications to aid in moving of teeth and/orimprovement of the condition of the teeth and/or gums of the patient maybe provided therein and dispensed through holes and/or passages formedin the interior and/or exterior sides of the repositioning jaw element.

A hollow repositioning jaw element can increase the flexibility of theshell to which the repositioning jaw element is attached. The increasedflexibility introduced can lower the functionality and/or the retentionof the dental appliance in a vertical or horizontal direction. Forexample, as a patient moves to a fully engaged sagittal jaw position andthe repositioning jaw elements interface, the force placed on the shellcan result in a gingival line of the shell flaring (e.g., moving away)from the gum line of the patient. In a number of embodiments, a numberof design features and/or elements can be used to reduce and/oreliminate the increase in flexibility, such as grooves and curvedrepositioning jaw elements (e.g., as discussed further herein in regardsto the embodiment of FIG. 4, among other locations).

In some embodiments, the repositioning jaw elements can be shaped tominimize and/or prevent degrading the retention and/or functionality ofthe shell of the dental appliance. For example, the buccal-lingual widthof a repositioning jaw element can be different on an occlusal surfaceof the repositioning jaw element (e.g., top surface) than on abuccal-lingual width of a surface of the repositioning jaw elementadjacent to the shell (e.g., bottom surface). For instance, thebuccal-lingual width of a repositioning jaw element can be wider on anocclusal surface of the repositioning jaw element than on abuccal-lingual width of a surface of the repositioning jaw elementadjacent to the shell. Such a shape can be similar to the constructionof an I-beam, as illustrated in the embodiment of FIG. 12D, with thewider buccal-lingual occlusal surface interfacing with an occlusalsurface of a repositioning jaw element positioned on an opposing jaw.

In accordance with some embodiments of the present disclosure, therepositioning jaw elements can be positioned on the removable dentalappliance near unerupted and/or removed 2^(nd) and/or 3^(rd) molarteeth. Repositioning jaw elements positioned on the removable dentalappliance near the unerupted and/or removed 2^(nd) and/or 3^(rd) molarteeth can, for instance, provide increased area for tooth movements.Alternatively and/or in addition, a spring feature can be positioned onthe removable dental appliance near unerupted and/or removed 2^(nd)and/or 3^(rd) molar teeth. For example, a spring feature can bepositioned on a first removable dental appliance and a tab feature canbe positioned on a second removable dental appliance to interface withthe spring feature. The spring feature can guide the lower jaw of thepatient to a position (e.g., a forward or backward position), forexample (e.g., as illustrated in the embodiment of FIG. 9B).

In a number of examples, a variety of features can be used in additionto and/or in place of repositioning jaw elements to guide the lower jawto a position (e.g., a forward or backward position). Example featurescan include connecting the first shell and the second shell usingmaterial at posterior sides of the shells, a rigid structure, and/orridges, among other features (e.g., as illustrated in the embodiments ofFIGS. 11A and 11B, as discussed further herein).

FIG. 2A illustrates a side view of an upper jaw 202 with a firstrepositioning jaw element 206 and a lower jaw 204 with a secondrepositioning jaw element 208 according to a number of embodiments ofthe present disclosure. The upper jaw 202, the first repositioning jawelement 206, the lower jaw 204, and the second repositioning jaw element208 illustrated in FIG. 2A can include virtual images of jaws andrepositioning jaw elements, respectively (e.g., virtual jaws and/orvirtual repositioning jaw elements), as discussed further herein. Asillustrated in the embodiment of FIG. 2A, the first repositioning jawelement 206 can be positioned near a buccal surface of the posteriorteeth (e.g., molars and bicuspids) of the upper jaw 202 of the patientto move the position (e.g., to move sagittally) of the lower jaw 204 ina forward direction or backward direction.

Although not illustrated in FIG. 2A, the first repositioning jaw element206 can extend from a buccal surface of a first shell of a dentalappliance. A buccal surface of a shell, as used herein, can include anexterior surface of a shell near the buccal surface of the teeththerein. Further, in various embodiments, the first repositioning jawelement 206 can be positioned near a lingual surface of the first shell.A lingual surface of a shell can include an exterior surface of theshell near the lingual surface of the teeth therein.

The second repositioning jaw element 208 can be positioned near a buccalsurface of the posterior teeth (e.g., bicuspids) of the lower jaw 204 ofthe patient to move the position of the lower jaw 204 in a forwarddirection or backward direction. Although not illustrated in FIG. 2A,the second repositioning jaw element 208 can extend from a buccalsurface of a second shell of a dental appliance.

The first repositioning jaw element 206 and the second repositioning jawelement 208 can interface. For instance, a first surface 228 of thefirst repositioning jaw element 206 can interface with a second surface230 of the second repositioning jaw element 208. The first repositioningjaw element 206 and the second repositioning jaw element 208 can bepositioned to interface in a presence of a temporary bite (e.g., a fullyengaged sagittal jaw position of the patient's upper dentition and thepatient's lower dentition) in a manner to reposition the patient's jaw.A fully engaged sagittal jaw position, as previously discussed, caninclude a relationship of the mandible and the maxilla when the upperand lower jaw are closed as far as the dental appliance with therepositioning jaw elements will allow (e.g., a partial occlusal jawposition).

For example, the first surface 228 of the first repositioning jawelement 206 interfacing with the second surface 230 of the secondrepositioning jaw element 208 can place a force on the patient's jaw toreposition the patient's jaw. The force can, for instance, sagittallymove the patient's lower jaw 204.

In various embodiments, at least one of the repositioning jaw elements206, 208 can extend past an occlusal plane of the upper jaw 202 and/orlower jaw 204 of the patient. For example, the first repositioning jawelement 206 can extend past the occlusal plane of the upper jaw 202 tointerface with the second repositioning jaw element 208. The secondrepositioning jaw element 208 may not extend past the occlusal plane ofthe lower jaw 204, for instance. Alternatively, the second repositioningjaw element 208 can extend past the occlusal plane of the lower jaw 204to interface with the first repositioning jaw element 206 and the firstrepositioning jaw element 206 may not extend past the occlusal plane ofthe upper jaw 202. Further, in some embodiments, both the firstrepositioning jaw element 206 and the second repositioning jaw element208 can extend past the occlusal plane of the upper jaw 202 and thelower jaw 204, respectively, to interface with one another.

FIG. 2B illustrates a front view of an upper jaw 202 with a firstrepositioning jaw element 206 and a third repositioning jaw element 210and a lower jaw 204 with a second repositioning jaw element 208 and afourth repositioning jaw element 212 according to a number ofembodiments of the present disclosure. The upper jaw 202, the firstrepositioning jaw element 206, the third repositioning jaw element 210,the lower jaw 204, the second repositioning jaw element 208, and thefourth repositioning jaw element 212 illustrated in FIG. 2B can includevirtual images of jaws and repositioning jaw elements, respectively(e.g., virtual jaws and/or virtual repositioning jaw elements), asdiscussed further herein. As illustrated by FIG. 2B, two repositioningjaw elements (e.g., the first repositioning jaw element 206 and thethird repositioning jaw element 210) can be positioned near buccalsurfaces of the upper jaw 202 and two repositioning jaw elements (e.g.,the second repositioning jaw element 208 and the fourth repositioningjaw element 212) can be positioned near buccal surfaces of the lower jaw204.

For example, the first repositioning jaw element 206 can be positionednear the buccal surfaces of posterior teeth (e.g., molars and/orbicuspids) of the upper jaw 202 and the second repositioning jaw element208 can be positioned near the buccal surfaces of posterior teeth (e.g.,bicuspids) of the lower jaw 204. The first repositioning jaw element 206and the second repositioning jaw element 208 can be located near a firstposterior side of the patient's dentition (e.g., positioned on a firstposterior side of a first shell and a second shell).

The first repositioning jaw element 206 and the second repositioning jawelement 208 can include surfaces designed to interact, interface, and/orotherwise engage with one another. For instance, a first surface of thefirst repositioning jaw element 206 can interface with a second surfaceof a second repositioning jaw element 208. The first surface can includea slanted surface on a mesial-facing surface of the first repositioningjaw element 206 and the second surface can include a slanted surface ona distal-facing surface of the first repositioning jaw element 208, forexample.

The third repositioning jaw element 210 can be positioned near thebuccal surfaces of posterior teeth (e.g., molars and/or bicuspids) ofthe upper jaw 202 and the fourth repositioning jaw element 212 can bepositioned near the buccal surfaces of posterior teeth (e.g., bicuspids)of the lower jaw 204. The third repositioning jaw element 210 and thefourth repositioning jaw element 212 can be located near a secondposterior side of the patient's dentition (e.g., positioned on a secondposterior side of a shell of a first shell and a second shell).

The third repositioning jaw element 210 and the fourth repositioning jawelement 212 can include surfaces designed to interact, interface, and/orotherwise engage with one another. For instance, a third surface of thethird repositioning jaw element 210 can interface with a fourth surfaceof the fourth repositioning jaw element 212. The third surface caninclude a slanted surface on a mesial-facing surface of the thirdrepositioning jaw element 210 and the fourth surface can include aslanted surface on a distal-facing surface of the fourth repositioningjaw element 212, for example.

The surfaces of the repositioning jaw elements 206, 208, 210, 212 can beangled, in various embodiments, to guide the lower jaw 204 into theintended and/or final jaw position and/or prevent unwanted lateralmovement. The surfaces can be angled in buccal-lingual and/ormesial-distal direction. The angle of the surfaces (e.g., two surfacesthat are designed to interface) can be comprised of supplemental angles(e.g., have the same slants at the interface).

For example, the first surface of the first repositioning jaw element206 and the second surface of the second repositioning jaw element 208can interface at a first slant. The third surface of the thirdrepositioning jaw element 210 and the fourth surface of the fourthrepositioning jaw element 212 can interface at a second slant.

Although not illustrated by the embodiments of FIG. 2B, the firstrepositioning jaw element 206 can extend from a buccal surface of afirst shell of a dental appliance and/or the second repositioning jawelement 208 can extend from a buccal surface of a second shell of thedental appliance. The first repositioning jaw element 206 and the secondrepositioning jaw element 208 can be located near a first side of thepatient's dentition (e.g., the right side of the patient's dentition).The third repositioning jaw element 210 can extend from a buccal surfaceof the first shell of the dental appliance and the fourth repositioningjaw element 212 can extend from a buccal surface of the second shell ofthe dental appliance. The third repositioning jaw element 210 and thefourth repositioning jaw element 212 can be located near a second sideof the patient's dentition (e.g., a left side of the patient'sdentition).

In some embodiments, repositioning jaw elements can extend from alingual surface of the shells. A lingual surface of a shell can includean exterior surface of the shell near the lingual surface of the teeththerein. For example, in some embodiments, the first repositioning jawelement 206 and third repositioning jaw element 210 can each extend froma lingual surface of the first shell and the second repositioning jawelement 208 and fourth repositioning jaw element 212 can each extendfrom a lingual surface of the second shell. Positioning therepositioning jaw elements on the lingual surface of the shell can, forinstance, result in a dental appliance that is more aestheticallypleasing to the patient because the repositioning jaw elements are lessvisible to others (e.g., decreasing the prominence of the repositioningjaw elements).

Alternatively and/or in addition, a number of repositioning jaw elementscan extend from a lingual surface of the shells and a number ofrepositioning jaw elements can extend from a buccal surface of the shell(e.g., as illustrated by FIGS. 13A-13B). In such embodiments, the firstrepositioning jaw element 206, the second repositioning jaw element 208,the third repositioning jaw element 210, and the fourth repositioningjaw element 212 can each extend from a buccal surface of the first shelland the second shell. In addition, a fifth repositioning jaw element canextend from a lingual surface of the first shell and a sixthrepositioning jaw element can extend from a lingual surface of thesecond shell; a seventh repositioning jaw element can extend from alingual surface of the first shell and a eighth repositioning jawelement can extend from a lingual surface of the second shell. The fifthrepositioning jaw element and sixth repositioning jaw element can belocated near the first side of the patient's dentition and the seventhrepositioning jaw element and eight repositioning jaw element can belocated near the second side of the patient's dentition. Positioningrepositioning jaw elements on the lingual surface of the shells inaddition to the buccal surface of the shells can, for instance, provideadditional stability, decrease the aesthetic prominence of therepositioning jaw elements, and/or limit lateral movement, among otherbenefits.

In some embodiments, a plurality of repositioning jaw elements canextend from the buccal surface of the first shell and a plurality ofrepositioning jaw elements can extend from the buccal surface of thesecond shell. The plurality of repositioning jaw elements extending frombuccal surfaces can, for instance, decrease the prominence of therepositioning jaw elements as compared to a single repositioning jawelement extending from each buccal surface.

In accordance with a number of embodiments, a repositioning jaw elementextending from a buccal surface can be used to treat crossbite in apatient. For instance, a repositioning jaw element extending from abuccal surface of a first shell and a repositioning jaw elementextending from a buccal surface of a second sell can interface to tip amolar tooth in a buccal direction to treat crossbite in a patient.

FIG. 3 illustrates an example of a method 320 for separating an upperdentition from a lower dentition according to a number of embodiments ofthe present disclosure. Separating the upper dentition from the lowerdentition according to the method 320 can allow for treatment ofmalocclusions such as excessive or inadequate overjet, excessive orinadequate overbite, and/or crossbite, for instance.

At block 322, the method 320 includes moving at least one tooth with adental appliance having a first shell configured to receive a number ofteeth of a patient's upper dentition, the number of teeth comprising theat least one tooth. That is, the first shell can include a shellconfigured to receive a number of teeth of the patient's upper dentitionand reposition at least one tooth of the number of teeth of thepatient's upper dentition.

At block 324, the method 320 includes separating a patient's upperdentition from the patient's lower dentition utilizing the dentalappliance. For instance, the separation can include separating theocclusal surfaces to a threshold distance to prevent an occlusal surfaceof the first shell from contacting an occlusal surface of a secondshell. The second shell can include a shell configured to receive anumber of teeth of the patient's lower dentition and reposition at leastone tooth of the number of teeth of the patient's lower dentition.

The dental appliance, at block 326, can interface a first surface of afirst repositioning jaw element of the first shell with a second surfaceof a second repositioning jaw element of a second shell of the dentalappliance. The second shell can, for instance, be configured to receivea number of teeth of the patient's lower dentition. The dental appliancecan separate occlusal surfaces of the number of teeth of the patient'supper dentition from the occlusal surfaces of the number of teeth of thepatient's lower dentition as the patient moves to a fully engagedsagittal jaw position, for example. The surface area of therepositioning jaw elements that engage the upper jaw/shell to the lowerjaw/shell while the disengaged areas are separated may be built so thatthe engagement is a better fit than the existing occlusion (e.g.,greater points or surfaces in contact) so that the preferred position ofthe patient is the engaged surface area instead of the currentocclusion.

A sagittal jaw position can include a relationship of the mandible andthe maxilla when the upper jaw and the lower jaw are closed and theteeth are in contact. A fully engaged sagittal jaw position, as usedherein, can include a relationship of the mandible and the maxilla whenthe upper and lower jaw are closed as far as the dental appliance withthe repositioning jaw elements will allow (e.g., as the first surface ofa first repositioning jaw element interfaces, interacts, and/or engagesthe second surface of the second repositioning jaw element). That is, ina fully engaged sagittal jaw position, at least some of the teeth of theupper jaw and at least some of the teeth of the lower jaw are not incontact. Further, in some embodiments, at least some of the occlusalsurface of the first shell and the occlusal surface of the second shellare not in contact in a fully engaged sagittal jaw position.

As previously discussed, the fully engaged sagittal jaw position may beneeded in the treatment of malocclusion such as excess or insufficientoverjet, excess or insufficient overbite, and/or crossbite. Forinstance, separating the occlusal surfaces can allow for moving a lowerjaw of the patient or opening up the bite to a desired range of jawopening extending from the current position of occlusion. It can alsoallow for decompression of a lower jaw forward from an undesirablebackwards position into a more comfortable (and esthetically pleasing)anteriorly displaced position. The advancement can be unilateral orbilateral.

In a number of embodiments in accordance with the present disclosure,the occlusal surfaces can be separated to a threshold distance toprevent an occlusal surface of the first shell from contacting anocclusal surface of the second shell. An example threshold distance canbe one millimeter, however, a treatment professional may determineanother suitable distance and such distances are within the scope of theembodiments of the present disclosure.

In various embodiments, the method 320 can include separating theocclusal surfaces of the number of teeth the patient's upper dentitionfrom the occlusal surfaces of the number of teeth of the patient's lowerdentition as the patient moves to the fully engaged sagittal jawposition in a plurality of incremental distances utilizing a pluralityof dental appliances. For example, the repositioning jaw elements can bedesigned to incrementally treat a malocclusion, such as excessive orinadequate overjet, excessive or inadequate overbite, and/or crossbiteby using repositioning jaw elements provided on a plurality of dentalappliances. In some embodiments, the increment can include a gradualmovement (e.g., sagittal movement) of the lower jaw by shifting theposition of the repositioning jaw elements and/or shifting the length ofone or more repositioning jaw elements on each of a series of theplurality of dental appliances (e.g., as discussed further herein withregard to FIG. 7).

FIGS. 4A-4C illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure. FIG. 4Aillustrates an example of two repositioning jaw elements 406, 408. Thetwo repositioning jaw elements 406, 408 can be virtual repositioning jawelements and/or physical repositioning jaw elements. The firstrepositioning jaw element 406 can include a first repositioning jawelement positioned on a first shell of the dental appliance. The secondrepositioning jaw element 408 can include a second repositioning jawelement positioned on a second shell of the dental appliance.

As illustrated by FIG. 4A, the first repositioning jaw element 408 caninclude a first surface 428 and the second repositioning jaw element 408can include a second surface 430. The first surface 428 can be a slantedsurface on a mesial-facing surface of the first repositioning jawelement 406 and the second surface 430 can be a slanted surface on adistal-facing surface of the second repositioning jaw element 408. Thesurfaces 428, 430 can interface at the slant (e.g., the angledsurfaces), for instance.

In a number of embodiments, a repositioning jaw element can include acurved back surface. For instance, a back surface (a surface on theopposite side relative to the surface that is designed to interface,interact, and/or engage a repositioning jaw element on an opposing jaw)of a repositioning jaw element can be curved in a distal direction. Asillustrated by FIG. 4A, the back surface of the first repositioning jawelement 406 is curved in a distal direction. The curving can, forinstance, improve comfort for a patient due to the reduction in sharpsurfaces exposed to the tongue and/or other soft tissues of the mouth.

FIG. 4B illustrates an example of a repositioning jaw element 434according to a number of embodiments of the present disclosure. Therepositioning jaw element 434 can include a virtual repositioning jawelement and/or a physical repositioning jaw element, for instance. Therepositioning jaw element 434 can include four side surfaces 436, 438,458 (e.g., the remaining side surface is facing away from the view). Thefirst side surface 436 can include a surface that can interface,interact, and/or engage with another surface of a repositioning jawelement on a shell of an opposing jaw. As illustrated, the first sidesurface 436 can be slanted. The second side surface 438 can include aback surface that is curved. For instance, the second side surface 438can be curved in a distal direction to improve comfort for the patient.

As illustrated by FIG. 4B, in various embodiments, a repositioning jawelement 434 can include a groove 440 on a top surface 452 of therepositioning jaw element 434. For instance, a reinforcement grooveand/or guide groove can be placed on a top surface 452 of a virtualand/or physical repositioning jaw element. The top surface 452 of arepositioning jaw element, as used herein, can include a surface of therepositioning jaw element extending toward an occlusal and/or coronalsurface of teeth on an opposing side of the patient's jaw. A groove, asused herein, can include a hollow channel within a repositioning jawelement. The groove 440 on the top surface 452 of the repositioning jawelement 434 can extend in a horizontal direction (e.g., a mesial-distaldirection), for instance.

Alternatively and/or in addition, in a variety of embodiments, arepositioning jaw element 434 can include a side groove on a buccal sidesurface and/or a lingual side surface (e.g., side surface 458) of arepositioning jaw element 434. A buccal side surface of a repositioningjaw element, as used herein, can include a side of the repositioning jawelement extending toward and/or adjacent to the cheek of the patient. Alingual side surface of the repositioning jaw element, as used herein,can include a side of the repositioning jaw element extending towardand/or adjacent to the tongue of the user. Grooves (e.g., a top grooveand/or number of side grooves) can, for example, increase a rigidity ofthe repositioning jaw element 434 as compared to a repositioning jawelement without grooves and/or can minimize and/or prevent degrading theretention and/or functionality of the shell of the dental appliance. Agroove can also function on the shell of each jaw during treatment.

In various instances, a plurality of side grooves 442-1, 442-2, 442-3,442-4, 442-5, 442-6 . . . 442-N) can be placed on the buccal sidesurface and/or the lingual side surface (e.g., side surface 458) of therepositioning jaw element 434. For example, the side grooves 442-1 . . .442-N can be placed on each of the buccal side surface and lingual sidesurface (e.g., side surface 458) of a virtual repositioning jaw elementand/or a physical repositioning jaw element. The side grooves 442-1 . .. 442-N can each include a hollow channel within the side surface of therepositioning jaw element 434. The side grooves 442-1 . . . 442-N canextend in vertical direction (e.g., an inferior-superior direction.) Asillustrated by FIG. 4B, in some embodiments, a repositioning jaw element434 can include a top groove 440 on a top surface 452 and side grooves442-1 . . . 442-N on side surfaces (e.g., side surface 458).

In some embodiments, the side grooves 442-1 . . . 442-N can includecoronal-apical grooves positioned at interproximal regions of at leastone of the number of teeth that the repositioning jaw element 434extends from. That is, each side groove can be placed at aninterproximal region of two teeth.

Although the present embodiment of FIG. 4B illustrates a top groove 440and a plurality of side grooves 442-1 . . . 442-N in a V-shape,embodiments in accordance with the present disclosure are not solimited. The grooves can include a variety of geometric shapes andsizes. For instance, the grooves can include portions of circles,hexagons, rectangles, and/or octagons, among other shapes and/or sizes.Geometric patterns may be used in lieu of grooves, so long as thepattern provides adequate structural rigidity that a groove or series ofgrooves may provide.

FIG. 4C illustrates an example of a repositioning jaw element 444according to a number of embodiments of the present disclosure. Therepositioning jaw element 444 can be a virtual repositioning jaw elementand/or a physical repositioning jaw element, for instance. Therepositioning jaw element 444 can include four side surfaces 436, 438,446 (the remaining side surface is facing away from the view). The firstside surface 436 can include a surface that can interface, interact,and/or engage with another surface. As illustrated, the first sidesurface 436 can be slanted. The second side surface 438 can include aback surface that is curved. For instance, the second side surface 436can be curved in a distal direction to improve comfort for the patient.Further, as illustrated by the repositioning jaw element 444 of FIG. 4C,the repositioning jaw element 444 can include a top groove 440 in thetop surface of the repositioning jaw element 444.

In accordance with some embodiments, a repositioning jaw element 444 caninclude curved side surfaces. For instance, a buccal side surface and/ora lingual side surface (e.g., side surface 446) can be curved in atleast one of a buccal and/or lingual direction. As illustrated by FIG.4C, the curved side surface 446 can include a bowed curve. For instance,the curved side surface 446 can result in the top surface of therepositioning jaw element 444 being shaped in a bone shape. A curvedside surface 446 can increase a rigidity of the repositioning jawelement 444 as compared to a non-curved side surface and/or can minimizeand/or prevent degrading the retention and/or functionality of the shellof the dental appliance, for example, by allowing greater surface areaof the shell to engage the teeth than if the side surfaces were notcurved.

FIGS. 5A-5C illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure. FIGS. 5A-5Cillustrate an example of a repositioning jaw element. The repositioningjaw element can be a virtual repositioning jaw element and/or a physicalrepositioning jaw element, in various embodiments. For instance, FIG. 5Aillustrates a top-down view 550 of the repositioning jaw element. Thetop-down view 550 of the repositioning jaw element can include a view oftwo side surfaces with side grooves 542-1, 542-2, 542-3, 542-4, 542-5,542-6, 542-7, 542-8, 542-9 . . . 542-P, a surface that can interface,interact, and/or engage with another surface 536, a back surface 538,and a top surface 552.

In accordance with some embodiments, side surfaces can be beveled. Forinstance, the buccal side surface and lingual side surface with sidegrooves 542-1 . . . 542-P can be beveled to include a differentbuccal-lingual width on a bottom than a top of the side surfaces of therepositioning jaw element. For example, the buccal-lingual width on thebottom can be wider than the buccal-lingual width on the top of the sidesurfaces of the repositioning jaw element. In such embodiments, theocclusal surface of the repositioning jaw element can have a narrowerbuccal-lingual width than a surface of the repositioning jaw elementadjacent to and/or near the shell of the dental appliance (e.g., bottomsurface of the repositioning jaw element). Beveling of the side surfacescan, for instance, include beveling the surface 536 and/or the backsurface 538 to have a wider buccal-lingual width on the top than thebottom of the side surfaces (e.g., as discussed further with regard toFIG. 5B). Beveling the side surfaces 536, 538 and side grooves 542-1 . .. 542-P can, for example, assist in manufacturing the dental appliancewhere the appliance is built from a positive reference model (e.g., suchas a 3D printed model or stereolithography (SLA) model).

The repositioning jaw element illustrated in FIG. 5A can include aplurality of side grooves 542-1 . . . 542-P on a buccal side surfaceand/or a mesial side surface. Beveling the buccal side surface and/orlingual side surface can, for instance, include beveling the sidegrooves 542-1 . . . 542-P. For instance, the buccal-lingual width of thebottom of the side grooves 542-1 . . . 542-P (the surface adjacent toand/or near the shell) can be wider than the buccal-lingual width of thetop of the side grooves 542-1 . . . 542-P (the surface of the sidegrooves adjacent to and/or near the top surface 552 of the repositioningjaw element).

FIG. 5B illustrates a view 553 of the repositioning jaw element. Therepositioning jaw element of FIGS. 5A and 5B can include the same and/ordifferent repositioning jaw elements, in various instances. For example,FIG. 5B can include a view of repositioning jaw element illustrated inthe embodiment of FIG. 5A from the point of view of arrow 541.

The view 553 of the repositioning jaw element can include a view of thesurface that can interface, interact, and/or engage with another surface(e.g., the surface 536 of FIG. 5A). For instance, the surface caninclude a top adjacent to a top surface 552 of the repositioning jawelement, a bottom adjacent to a bottom surface 554 of the repositioningjaw element, and two sides adjacent to the buccal and/or lingual sidesurfaces 531-1, 531-2 of the repositioning jaw element.

As illustrated by FIG. 5B, the buccal-lingual width of the surface canbe beveled. For instance, the buccal-lingual width of the bottom of thesurface (e.g., adjacent to the bottom surface 554 of the repositioningjaw element) can be wider than the buccal-lingual width of the top ofthe surface (e.g., adjacent to the top surface 552 of the repositioningjaw element).

Further, as illustrated by the arrow 556, the surface that caninterface, interact, and/or engage with another surface can be slanted.For instance, the surface can be slanted at an angle in a mesial-distaldirection.

FIG. 5C illustrates an example side view 560 of a repositioning jawelement. The repositioning jaw element can be a virtual repositioningjaw element and/or a physical repositioning jaw element, in someembodiments. The repositioning jaw element of FIGS. 5A, 5B, and 5C caninclude the same and/or different repositioning jaw elements, in variousinstances. For example, FIG. 5C can include a view of repositioning jawelement illustrated in the embodiment of FIG. 5A from the point of viewof arrow 543. The side view 560 can include a view of a buccal and/orlingual side surface 558. The buccal and/or lingual side surface 558 caninclude a top adjacent to a top surface 552 of the repositioning jawelement, a bottom adjacent to a bottom surface 554 of the repositioningjaw element, a first side adjacent to the surface that can interface,interact, and/or engage with another surface 536 of the repositioningjaw element, and a second side adjacent to a back surface 538 of therepositioning jaw element. The buccal and/or lingual side surface 558,as illustrated by FIG. 5C, can include a plurality of side grooves.

As illustrated by FIG. 5C, repositioning jaw elements in accordance withthe present disclosure can include a slant in height from the surface536 to the back surface 538. For instance, the slant in height caninclude a higher coronal-apical height of a repositioning jaw element ina mesial direction than a coronal-apical height of the repositioning jawelement in a distal direction. Such a slant can, for instance, create amore comfortable experience for the patient as the jaw of the patientmay not close in a flat direction (e.g., not parallel to a horizontalplane). In other words, the vertical distance between the upper jaw andthe lower jaw may be greater in the anterior region than in theposterior region for some patients or greater in the posterior regionthan in the anterior region for others, depending on the originalpositioned and the desired position (e.g., the intended and/or finalposition) of the jaw. By accommodating these variances, the patient mayocclude in more points (and the temporary bite will be more stable) thanif an even flat plane was designed into the temporary bite.

FIG. 6 illustrates an example computing device readable medium havingexecutable instructions that can be executed by a processor to perform amethod according to one or more embodiments of the present disclosure.For instance, a computing device 664 can have a number of componentscoupled thereto. The computing device 664 can include a processor 666and a memory 668. The memory 668 can have various types of informationincluding data 670 and executable instructions 672, as discussed herein.

The processor 666 can execute instructions 672 that are stored on aninternal or external non-transitory computer device readable medium(CRM). A non-transitory CRM, as used herein, can include volatile and/ornon-volatile memory. Volatile memory can include memory that dependsupon power to store information, such as various types of dynamic randomaccess memory (DRAM), among others. Non-volatile memory can includememory that does not depend upon power to store information.

Memory 668 and/or the processor 666 may be located on the computingdevice 664 or off the computing device 664, in some embodiments. Assuch, as illustrated in the embodiment of FIG. 6, the computing device664 can include a network interface 674. Such an interface 674 can allowfor processing on another networked computing device, can be used toobtain information about the patient, and/or can be used to obtain dataand/or executable instructions for use with various embodiments providedherein.

As illustrated in the embodiment of FIG. 6, the computing device 664 caninclude one or more input and/or output interfaces 678. Such interfaces678 can be used to connect the computing device 664 with one or moreinput and/or output devices 680, 682, 684, 686, 688.

For example, in the embodiment illustrated in FIG. 6, the input and/oroutput devices can include a scanning device 680, a camera dock 682, aninput device 684 (e.g., a mouse, a keyboard, etc.), a display device 686(e.g., a monitor), a printer 688, and/or one or more other inputdevices. The input/output interfaces 678 can receive executableinstructions and/or data, storable in the data storage device (e.g.,memory), representing a virtual dental model of a patient's dentition.

In some embodiments, the scanning device 680 can be configured to scanone or more physical dental molds of a patient's dentition. In one ormore embodiments, the scanning device 680 can be configured to scan thepatient's dentition and/or dental appliance directly. The scanningdevice 680 can be configured to input data into the computing device664.

In some embodiments, the camera dock 682 can receive an input from animaging device (e.g., a 2D or 3D imaging device) such as a digitalcamera, a printed photograph scanner, and/or other suitable imagingdevice. The input from the imaging device can, for example, be stored inmemory 668.

The processor 666 can execute instructions to provide a visualindication of a treatment plan, a dental appliance, and/or arepositioning jaw element on the display 686. The computing device 664can be configured to allow a treatment professional or other user toinput treatment goals. Input received can be sent to the processor 666as data 670 and/or can be stored in memory 668.

Such connectivity can allow for the input and/or output of data and/orinstructions among other types of information. Some embodiments may bedistributed among various computing devices within one or more networks,and such systems as illustrated in FIG. 6 can be beneficial in allowingfor the capture, calculation, and/or analysis of information discussedherein.

The processor 666, in association with the data storage device (e.g.,memory 668), can be associated with the data 670. The processor 666, inassociation with the memory 668, can store and/or utilize data 670and/or execute instructions 672 for placing virtual repositioning jawelements on a shell of a virtual model of a dental appliance. Such datacan include the virtual dental model. The virtual model of the dentalappliance with the repositioning jaw element can be used to create aphysical dental appliance, for instance, as discussed further herein.

The processor 666 coupled to the memory 668 can cause the computingdevice 664 to perform a method including, for example, providing avirtual model of a dental appliance having a shell configured toreposition a number of teeth of a patient. In various embodiments of thepresent disclosure, the processor 666 coupled to the memory 668 cancause the computing device 664 to perform the method includingpositioning a virtual repositioning jaw element on the shell of thevirtual model of the dental appliance parallel to a bite plane of thepatient, wherein the repositioning jaw element extends from a surface ofthe shell of the virtual model of the dental appliance.

For instance, to position the virtual repositioning jaw element parallelto a bite plane can include, in some embodiments, removing a virtualimage of the number teeth of the patient. With the teeth removed, avirtual representation of the bite plane of the patient can remain andthe virtual repositioning jaw element can be positioned parallel to thebite plane.

Further, in some embodiments, the processor 666 coupled to the memory668 can cause the computing device 664 to perform the method includingrevising the position of the virtual repositioning jaw element to alignwith a midline of at least one tooth of the number of teeth. Forinstance, in some embodiments, the virtual image of the number of teethcan be displayed (e.g., such as, after being removed) and the positionof the virtual repositioning jaw element can be automatically revised toalign with the midline of the at least one tooth that the virtualrepositioning jaw element extends from.

In some embodiments, the processor 666 coupled to the memory 668 cancause the computing device 664 to perform the method includingdetermining a degree of the patient's jaw alignment utilizing a virtualimage of the jaw of the patient. The virtual image of the jaw of patientcan include a virtual image of the mandible, its related soft and hardtissue, a number of teeth the patient's lower dentition, the maxilla,its related soft and hard tissues, and/or a number of teeth of thepatient's lower dentition. The degree of the patient's jaw alignment caninclude, for instance, a path of articulation or jaw opening andclosing. It may also include a repositioned location such as a protrudedposition, or a combination of semi-articulation and protrusion, forexample.

A dental appliance can be made, for example, by thermal-forming a sheetof plastic over a physical dental mold. The physical dental mold, forinstance, can represent an incremental position to which a patient'steeth are to be moved. The physical dental mold can be manufactured bydownloading a computer-aided Design (CAD) virtual dental model to arapid prototyping process, such as, for example, a computer-aidedmanufacturing (CAM) milling, stereolithography, and/or photolithography.The virtual dental mold can be hollowed out or “shelled” before sent formanufacturing to save on material cost, for example.

The dental mold (e.g., set of molded teeth) can be created from avirtual model of a number of teeth of a patient. A virtual model, forexample, can include an initial virtual dental model and/or intermediatevirtual dental model. A dental mold can be formed in accordance with aunique treatment file that identifies a patient, a stage of a treatmentplan, the virtual model of the number of teeth, and/or whether thedental mold is of the upper and/or lower dental arch.

In some embodiments, a treatment file can be accessed by a rapidprototyping apparatus machine, such as a SLA or 3D printing, to formand/or create the dental mold. The result of the dental mold can includea set of molded teeth. The set of molded teeth can include at least areplica of the number of teeth of the patient. The dental mold can beused to make a dental appliance, for example, by creating a negativeimpression of the dental mold using polymeric sheets of material andvacuum forming the sheets over the dental mold, as discussed above.

For instance, a dental appliance can be formed by layering athermoformable sheet of material and/or multiple sheets of one or morematerials over the dental mold. The materials can include a polymericmaterial, for instance. Generally, the dental appliance is producedand/or formed by heating the polymeric thermoformable sheet and vacuumor pressure forming the sheet over the dental mold (e.g., a number ofmolded teeth). The shape of the sheet of material can change thicknesson some portions of the sheet as it conforms to the mold shape. A dentalappliance can, for example, include a negative impression of the dentalmold. The appliance and/or parts thereof may be transparent,semi-transparent, or opaque in such a way as to emulate a nature toothshade.

However, embodiments in accordance with present disclosure are not solimited. For example, embodiments in accordance with the presentdisclosure can include forming a dental appliance utilizing a variety oftechniques, such as SLA or 3D printing, among other techniques.

In a number of embodiments, the processor 666 coupled to the memory 668can cause the computing device 664 to perform the method of providing atreatment plan. One or more appliances, including positioners,retainers, removable dental appliances, and/or other appliances forfinishing and maintaining teeth positioning, can be utilized by atreatment professional in performing a treatment plan. The treatmentplan can include the use of one or more dental appliances, as describedherein.

For example, the processor 666 coupled to the memory 668 can cause thecomputing device 664 to perform the method comprising identifying amisaligned jaw of a patient from a virtual image of the patient's jaw.The identification can include, for instance, determining a degree ofthe patient's jaw alignment utilizing the virtual image of the patient'sjaw.

In some embodiments, the processor 666 coupled to the memory 668 cancause the computing device 664 to perform the method comprisingproviding a treatment plan for the patient. The treatment plan caninclude a virtual model of a dental appliance having a first shell and asecond shell configured to reposition at least one tooth of the patient.The at least one tooth can, for instance, include a tooth on a lower jawand/or a tooth on an upper jaw of the patient. Further, the virtualmodel of the dental appliance can include repositioning jaw elements onthe first shell and the second shell configured to move a position ofthe misaligned jaw of the patient (e.g., to move sagittally a positionof the misaligned jaw of the patient).

The repositioning jaw elements on the first shell and the second shellcan be designed based on an aim of repositioning the misaligned jaw ofthe patient. A particular repositioning jaw element can have a shape andangle specific to a treatment plan based on at least one of a finaland/or intended jaw position, an intended use (e.g., Class I correction,Class II correction, and/or Class III correction), and/or an orientationof a tooth over which the repositioning jaw element is positioned.

According to a number of embodiments of the present disclosure,providing a treatment plan for the patient can include identifying afinal jaw position of the patient. The final jaw position of the patientcan include, for instance, an improved and/or optimized jaw position.For instance, the final jaw position may include simultaneous contactingof the upper and lower teeth on the right and left sides, and in theanterior and posterior occlusal areas with maximum interdigitation, abest fit or seating of the condyles of the mandible within the jointhousing of the temporal bone, and/or correction of malocclusions.

The identified final jaw position can be used to design the virtualrepositioning jaw elements. For instance, the virtual repositioning jawelements can be designed to move the position of the misaligned jaw ofthe patient toward and/or to the final jaw position (e.g., to movesagittally).

Alternatively and/or in addition, a plurality of dental appliances(e.g., a series of dental appliances) can be used to move the positionof the misaligned jaw of the patient toward and/or to the final jawposition. For example, in some embodiments, providing the treatment plancan include providing a virtual model of a plurality of dentalappliances. The plurality of dental appliances can be configured toreposition the misaligned jaw in incremental distances according to anumber of stages of a treatment plan (e.g., as discussed further withregard to the embodiments illustrated in FIGS. 7A-7D).

The shape and angle of each of the repositioning jaw elements can bespecific to a stage of a treatment plan for which the appliance wasdesigned (e.g., successive appliances created according to a treatmentplan may have differently positioned, angled, and/or shapedrepositioning jaw elements). Repositioning jaw elements that have shapesand angles specific to particular stages of treatment can beadvantageous over using generic and/or uniform repositioning jaw elementthat are not specific to treatment stages and therefore may notaccurately provide the desired correction for the treatment stage duringwhich they are used. Such inaccurate treatment can lead to lengtheningtreatment plans, a need for a revised treatment plan, and/or unnecessaryuser discomfort, among other drawbacks. In contrast, a number ofembodiments of the present disclosure allow for more timely, accurate,and/or comfortable execution of treatment plans.

In various embodiments, the processor 666 coupled to the memory 668 cancause the computing device 664 to perform the method comprisingvirtually testing the jaw movement to occur by the patient wearing thedental appliance. The virtual testing can include testing jaw movement,in addition to movement of teeth, in a number of embodiments. Thevirtual repositioning jaw elements can be adjusted based on the virtualtesting of the jaw movement. For instance, the virtual repositioning jawelements can be adjusted to reach an intended jaw position and/or afinal jaw position in a treatment plan. The virtual testing and/oradjustment, in some embodiments, can be across a number of stages of atreatment plan.

For example, for each stage of a treatment plan, the instructions can beexecuted to model forces applied to a virtual model of the jaw by anappliance corresponding to that stage (to simulate actual forces to beapplied to a user's physical jaw by a physical appliance). Those forcescan include forces applied to the virtual model of the jaw by thevirtual repositioning jaw elements, by virtue of the appliance beingslightly out of alignment with a current configuration of the virtualmodel of the teeth and/or include forces applied to the aligner by theuser (e.g., when the user wears the physical dental appliance).

The instructions can be executed to position the virtual repositioningjaw elements on the digital teeth of the virtual model of the jaw at aparticular stage of treatment and/or adjust a position of the virtualrepositioning jaw elements for subsequent stages of treatment. Thevirtual model of the jaw can be different at each stage of treatmentaccording to the treatment plan (e.g., positioning of the virtual teethand/or jaw can change). The instructions can be executed to adjust theposition of the virtual repositioning jaw elements according to changesto the virtual model of the jaw between treatment stages and/oraccording to anticipated changes in subsequent stages of treatment(e.g., to help effectuate a desired change to the virtual model of thejaw).

Positioning and/or adjustment of positioning of virtual repositioningjaw elements on a virtual model of a jaw can be automatic (e.g., byoperation of software based on force modeling for a particular stage oftreatment), manual (e.g., by operation of an operator interacting withthe virtual model via an interface with a computing device), or acombination thereof. Likewise, the shape, size, orientation (e.g.,various angles with respect to references), and/or attachment location(on the virtual teeth) of the virtual repositioning jaw elements can beautomatically set by the software, by manual operation (e.g., anoperator can specify the necessary criteria of the virtual repositioningjaw elements and/or modify default criteria provided by the software),or a combination thereof.

FIGS. 7A-7D illustrate examples of a plurality of devices forrepositioning jaws according to a number of embodiments of the presentdisclosure. In some embodiments of the present disclosure, a pluralityof dental appliances can be used for treating misalignment of teeth of apatient and/or misalignment of the patient's jaw. For example, atreatment plan can be divided into multiple parts (also called stages)wherein dental appliances (in this case, an appliance having an uppershell and lower shell) are used in succession to move one or more of thepatient's teeth and/or jaw from an initial position to a targetposition. And, wherein specialized dental appliances can be designed foreach stage of treatment having cavities with particular dimensions andorientations in which teeth are placed to move one or more of the teethto a particular position during the particular stage of treatment and/orto move the jaw to a new position when the jaw is closed (e.g., to aidthe jaw in following a different path from an open to a closed positionto change the path from an initial path to a target path wherein thedifferent path results in a new position of the jaw when it is fullyclosed). Such a change in jaw path can be accomplished with one deviceor incrementally with several devices wherein the repositioning jawelements are in different positions and/or orientations with respect toeach other and/or the shell on which they are connected. Accordingly, asdiscussed above, each of the plurality of dental device appliances caninclude a treatment stage in an incremental treatment plan.

For example, the plurality of devices can include a series of dentalappliances designed to incrementally implement a treatment plan. Forinstance, the series of dental appliances can incrementally move aposition of the patient's jaw (when the jaw is viewed in its fullyclosed orientation) from stage to stage. The movement of the position ofthe jaw can include a revised position of the lower jaw of the patientrelative to the upper jaw of the patient. Each stage of the treatmentplan can move the position of the patient's jaw an incremental distance(e.g., 0.1 mm) from the previous position of the patient's jaw, asdiscussed further herein. From one stage to the next stage, the positionof the patient's jaw can progress toward a final or target jaw position.

The incremental movement of the patient's jaw can occur based on the useof repositioning jaw elements that have slightly different positions ororientations on the shells from stage to stage. For example, thepositioning of repositioning jaw elements extending from a first shelland/or second shell of a dental appliance can be revised from a firststage to a second stage. The revised positioning can include changing amesial-distal length and/or a mesial-distal placement of a repositioningjaw element from one stage (e.g., a first dental appliance) to a nextstage (e.g., a second dental appliance), as discussed further herein.

As used herein, a “first stage” does not necessarily mean the originalstage of a treatment plan, but is a relative term with respect to otherstages. For example, the “first stage” may be a second stage of a 50stage treatment plan, while the “second stage” may be a tenth stage ofthe 50 stage treatment plan, while the “third stage” may be a 30th stageof the 50 stage treatment plan, and the “fourth stage” may be a 40thstage of the 50 stage treatment plan.

The treatment plan may just treat the position of the jaw or, in someembodiments, the treatment of the position of the jaws can be combinedwith the movement of one or more teeth on one or both jaws. Forinstance, the series of dental appliances can be used to incrementally(e.g., in increments of 0.1 mm) move a position of a misaligned jaw of apatient. This can be beneficial as typical current jaw alignmenttechniques move a jaw in large increments, such as 0.5 mm or greater,which may cause discomfort to the patient, among other issues.

As discussed above, one or more of the series of dental appliances canalso be configured to reposition a number of teeth of the patient'sdentition. In some embodiments, one or more of the series of dentalappliances can be configured to reposition a number of teeth of thepatient's dentition simultaneously with moving a position of a jaw ofthe patient. An example series of dental appliances can include a firstdental appliance comprising a first shell having a first repositioningjaw element extending therefrom and a second shell having a secondrepositioning jaw element extending therefrom. The first dentalappliance can be associated with and/or a part of an initial stage of atreatment plan (e.g., a first stage). The first dental appliance can beconfigured to move a misaligned jaw of the patient to a firstincremental jaw position. Jaw positions can be compared when the jaw ispositioned in a similar open-closed position along its path. Forexample, a comparison can be made when the jaw is in a fully engagedsagittal jaw position. Alternatively, a comparison could be made atother positions of the repositioning jaw elements, for example, when therepositioning jaw elements first contact each other.

The series of dental appliances can include a second dental appliancecomprising a first shell having a first repositioning jaw elementextending therefrom and a second shell having a second repositioning jawelement extending therefrom. The second dental appliance can beassociated with and/or a part of a second stage of the treatment plan(e.g., a subsequent stage to the initial stage). The second dentalappliance can be configured to move the misaligned jaw of the patient toa second incremental position.

For example, the second dental appliance can move the misaligned jawbased on the first repositioning jaw element and the secondrepositioning jaw element having a second position specific to a secondstage of the treatment plan. In this manner, the movement induced by useof the repositioning jaw elements can be divided into increments whichmay allow the movement to be more precise, may allow for more complexmovements, and may allow for less discomfort to the patient.

A non-engaged sagittal jaw position, as used herein, can include aposition of the patient's upper jaw and lower jaw when the repositioningjaw elements of the first shell and the repositioning jaw elements ofthe second shell are not interfacing, interacting, and/or engaging(e.g., not touching). For instance, a non-engaged sagittal jaw positionmay include a position of the first shell and the second shell such thatthe repositioning jaw elements are not providing a force to move (e.g.,sagittally) the patient's jaw.

An engaged sagittal jaw position, as used herein, can include a positionof the patient's upper jaw and lower jaw when the repositioning jawelements of the first shell and the repositioning jaw elements of thesecond shell are interfacing, interacting, and/or engaging. For example,an engaged sagittal jaw position may include a position of the firstshell and the second shell such that the repositioning jaw elements areproviding a force to move (e.g., sagittally) the patient's jaw. Asdiscussed herein, in various embodiments, the dental appliance may movea jaw of the patient in one or more other directions in addition tosagittal movement.

Although the present embodiment illustrates two dental appliances in aseries of dental appliances, embodiments in accordance with the presentdisclosure are not so limited. Treatment plans can include a variety ofnumber of dental appliances, including more or less than two dentalappliances.

As discussed above, each treatment stage can include a gradual movementof a lower jaw of a patient. The increments can occur based on changesin the mesial-distal length of the repositioning jaw elements and/orshifts in placement of the repositioning jaw elements on the shell (e.g.shift at least one repositioning jaw element in a mesial or distaldirection).

For example, as illustrated in each embodiment of FIGS. 7A-7D, thetreatment plan can include a number of treatment stages. The embodimentsof FIGS. 7A-7D each illustrate two treatment stages. Each of thetreatment stages can include a removable dental appliance with a firstshell (e.g., first shell 714-1 of the first stage and first shell 714-2of the second stage of FIGS. 7A-7D, herein generally referred to as“first shell 714”) and a second shell (e.g., second shell 716-1 of thefirst stage and second shell 716-2 of the second stage of FIGS. 7A-7D,herein generally referred to as “second shell 716”).

Each first shell 714 can have a number of tooth apertures configured toreceive and reposition a number of teeth of a patient's upper dentitionand each second shell 716 can have a number of tooth aperturesconfigured to receive and reposition a number of teeth of the patient'slower dentition. A first repositioning jaw element (e.g., 706-1 of thefirst stage and 706-2 of the second stage of FIGS. 7A-7D, hereingenerally referred to as “first repositioning jaw element 706”) canextend from a surface the first shell 714 and can include a firstsurface. A second repositioning jaw element (e.g., 708-1 of the firststage and 708-2 of the second stage of FIGS. 7A-7D, herein generallyreferred to as “second repositioning jaw element 708) can extend from asurface the second shell 716 and include a second surface to interface,interact, and/or engage with the first surface of the firstrepositioning jaw element 706.

For instance, the first repositioning jaw element 706 and the secondrepositioning jaw element 708 of each dental appliance can be positionedto interface in the presence of a fully engaged sagittal jaw position ofthe patient's upper dentition and the patient's lower dentition in amanner to reposition the patient's jaw. For instance, the repositioningcan include a forward and downward movement of the patient's lower jaw(e.g., to sagittally move).

Each dental appliance in the treatment plan (e.g., at each treatmentstage) can be configured to reposition the number of teeth of thepatient's upper dentition and the number of teeth of the patient's lowerdentition and/or reposition of the patient's jaw. For instance, therepositioning of the patient's jaw can be incremental across the numberof treatment stages. An incremental reposition of the patient's jaw caninclude, for instance, gradual advancement of the lower jaw. Asdescribed further herein, the gradual advancement can be achieved byshifting the placement of at least one of the repositioning jaw elementsfrom a first stage (e.g., first dental appliance) to a second stage(e.g., second dental appliance) and/or changing the mesial-distal lengthof at least one of the repositioning jaw elements from a first stage toa second stage of the treatment plan.

The embodiments of FIGS. 7A-7D can illustrate repositioning jaw elements706, 708 oriented in a horizontal line. For instance, each horizontalline can represent a side view of (e.g., shells) a jaw pair (e.g., anupper jaw and a lower jaw). Although not illustrated by FIG. 7A-7D, therepositioning jaw elements 706, 708 can be positioned to extend from asurface of a shell 714, 716 that is shaped to substantially follow adental arch of a patient. As such, the left end points of each ofFigures of 7A-7D represent a posterior direction 745 and/or regions ofthe jaws (e.g., of the patient when the dental appliance is worn) andthe right end points of each of the FIGS. 7A-7D represent anteriordirections 747 and/or regions of the jaws (e.g., of the patient when theremovable dental appliance is worn). The repositioning jaw elements 706,708 extend from the surfaces of the shells.

FIG. 7A illustrates an example of a number of treatment stages toreposition a jaw of a patient in gradual advancements by changing amesial-distal length of a first repositioning jaw element. Changing amesial-distal length of a repositioning jaw element, as used herein, caninclude increasing or decreasing the length of the repositioning jawelement along a mesial-distal plane of teeth of the patient. Forinstance, the first treatment stage can include a first repositioningjaw element 706-1 that extends from a surface of a first shell 714-1configured to receive and reposition a number of teeth of a patient'supper dentition. A second repositioning jaw element 708-1 can extendfrom a surface of a second shell 716-1 configured to receive andreposition a number of teeth of the patient's lower dentition.

The mesial-distal length of the first repositioning jaw element 706-1and the second repositioning jaw element 708-1 can include particularlengths based on the first treatment stage. For instance, the length canbe based on an incremental distance of the particular treatment stage.Based on the mesial-distal lengths of the first repositioning jawelement 706-1 and the second repositioning jaw element 708-1 of thefirst treatment stage, the patient's jaw can be repositioned to a firstincremental position and/or distance.

In some embodiments, as illustrated by FIG. 7A-D, the firstrepositioning jaw elements 706 can include a longer mesial-distal lengththan the second repositioning jaw elements 708. In some instances, apatient may have posterior teeth on the lower jaw that have not yetfully erupted. The longer mesial-distal length of the firstrepositioning jaw elements 706 on the first shell 714 can minimizeand/or prevent the posterior teeth on the lower jaw from eruptingfarther than is desirable (e.g., super eruption) while still allowingthe posterior teeth to erupt.

A second treatment stage can include a first repositioning jaw element706-2 that extends from a surface of a first shell 714-2 configured toreceive and reposition a number of teeth of the patient's upperdentition. A second repositioning jaw element 708-2 can extend from asurface of a second shell 716-2 configured to receive and reposition anumber of teeth of the patient's lower dentition.

The mesial-distal length of the first repositioning jaw element 706-2 ofthe second treatment stage can be increased from the mesial-distallength of the first repositioning jaw element 706-1 of the firsttreatment stage. The increase in mesial-distal length can be based onthe incremental distance of the particular treatment stage. The changecan include, for example, a particular distance value x 791 (e.g.,increase by particular distance value x 791) in which the mesial surfaceof repositioning jaw element 706-2 is extended by a distance “x” in themesial direction. The second repositioning jaw element 708-2 of thesecond treatment stage can be the same mesial-distal length as thesecond repositioning jaw element 708-1 of the first treatment stageand/or can be increased, in various embodiments. Based on themesial-distal lengths of the first repositioning jaw element 706-2 andthe second repositioning jaw element 708-2 of the second treatmentstage, the patient's jaw can be repositioned to a second incrementalposition and/or distance.

FIG. 7B illustrates an example of a number of treatment stages toreposition a jaw of a patient in gradual advancements by changing amesial-distal length of a second repositioning jaw element. Forinstance, the first treatment stage can include a first repositioningjaw element 706-1 that extends from a surface of a first shell 714-1configured to receive and reposition a number of teeth of a patient'supper dentition. A second repositioning jaw element 708-1 can extendfrom a surface of a second shell 716-1 configured to receive andreposition a number of teeth of the patient's lower dentition.

The mesial-distal length of the first repositioning jaw element 706-1and the second repositioning jaw element 708-1 can include particularlengths based on the first treatment stage. The length can be based onan incremental distance of the particular treatment stage. Based on themesial-distal lengths of the first repositioning jaw element 706-1 andthe second repositioning jaw element 708-1 of the first treatment stage,the patient's jaw can be repositioned to a first incremental positionand/or distance.

A second treatment stage can include a first repositioning jaw element706-2 that extends from a surface of a first shell 714-2 configured toreceive and reposition a number of teeth of the patient's upperdentition. A second repositioning jaw element 708-2 can extend from asurface of a second shell 716-2 configured to receive and reposition anumber of teeth of the patient's lower dentition.

The mesial-distal length of the second repositioning jaw element 708-2of the second treatment stage can be increased from the mesial-distallength of the second repositioning jaw element 708-1 of the firsttreatment stage. The increase in mesial-distal length can be based onthe incremental distance of the particular treatment stage. The changecan include, for example, a particular distance value x 792 (e.g.,increase by distance value x 792) in which the mesial surface ofrepositioning jaw element 708-2 is extended by a distance “x” in thedistal direction. The first repositioning jaw element 706-2 of thesecond treatment stage can be the same mesial-distal length as the firstrepositioning jaw element 706-1 of the first treatment stage and/or canbe increased, in various embodiments. Based on the mesial-distal lengthsof the first repositioning jaw element 706-2 and the secondrepositioning jaw element 708-2 of the second treatment stage, thepatient's jaw can be repositioned to a second incremental positionand/or distance.

FIG. 7C illustrates an example of a number of treatment stages toreposition a jaw of a patient in gradual advancements by shifting amesial-distal placement (e.g., shift the placement of the repositioningjaw element in a mesial or distal direction) of the first repositioningjaw element. For instance, the first treatment stage can include a firstrepositioning jaw element 706-1 that extends from a surface of a firstshell 714-1 configured to receive and reposition a number of teeth of apatient's upper dentition. A second repositioning jaw element 708-1 canextend from a surface of a second shell 716-1 configured to receive andreposition a number of teeth of the patient's lower dentition.

The mesial-distal placement of the first repositioning jaw element 706-1and the second repositioning jaw element 708-1 can include a particularplacement adjacent to posterior teeth therein based on the firsttreatment stage. For instance, the placement can be based on anincremental distance of the particular treatment stage. Based on themesial-distal placement of the first repositioning jaw element 706-1 andthe second repositioning jaw element 708-1 of the first treatment stage,the patient's jaw can be repositioned to a first incremental positionand/or distance.

A second treatment stage can include a first repositioning jaw element706-2 that extends from a surface of a first shell 714-2 configured toreceive and reposition a number of teeth of the patient's upperdentition. A second repositioning jaw element 708-2 can extend from asurface of a second shell 716-2 configured to receive and reposition anumber of teeth of the patient's lower dentition.

The mesial-distal placement of the first repositioning jaw element 706-2of the second treatment stage can be shifted in a mesial direction fromthe mesial-distal placement of the first repositioning jaw element 706-1of the first treatment stage. The shift in mesial-distal placement canbe based on the incremental distance of the particular treatment stage.The shift can include, for example, a particular distance value x 793(e.g., shift in a mesial direction by a distance value of x 793). Thesecond repositioning jaw element 708-2 of the second treatment stage canbe the same mesial-distal placement as the second repositioning jawelement 708-1 of the first treatment stage and/or can be shifted, invarious embodiments. Based on the mesial-distal placements of the firstrepositioning jaw element 706-2 and the second repositioning jaw element708-2 of the second treatment stage, the patient's jaw can berepositioned to a second incremental position and/or distance.

FIG. 7D an example of a number of treatment stages to reposition a jawof a patient in gradual advancements by shifting a mesial-distalplacement of the second repositioning jaw element. For instance, thefirst treatment stage can include a first repositioning jaw element706-1 that extends from a surface of a first shell 714-1 configured toreceive and reposition a number of teeth of a patient's upper dentition.A second repositioning jaw element 708-1 can extend from a surface of asecond shell 716-1 configured to receive and reposition a number ofteeth of the patient's lower dentition.

The mesial-distal placement of the first repositioning jaw element 706-1and the second repositioning jaw element 708-1 can include a particularplacement adjacent to posterior teeth therein based on the firsttreatment stage. For instance, the placement can be based on anincremental distance of the particular treatment stage. Based on themesial-distal placement of the first repositioning jaw element 706-1 andthe second repositioning jaw element 708-1 of the first treatment stage,the patient's jaw can be repositioned to a first incremental positionand/or distance.

A second treatment stage can include a first repositioning jaw element706-2 that extends from a surface of a first shell 714-2 configured toreceive and reposition a number of teeth of the patient's upperdentition. A second repositioning jaw element 708-2 can extend from asurface of a second shell 716-2 configured to receive and reposition anumber of teeth of the patient's lower dentition.

The mesial-distal placement of the second repositioning jaw element708-2 of the second treatment stage can be shifted in a distal directionfrom the mesial-distal placement of the second repositioning jaw element708-1 of the first treatment stage. The shift in mesial-distal placementcan be based on the incremental distance of the particular treatmentstage. The shift can include, for example, a particular distance value x794 (e.g., shift in a distal direction by a distance value of x 794).The first repositioning jaw element 706-2 of the second treatment stagecan be the same mesial-distal placement as the first repositioning jawelement 706-1 of the first treatment stage and/or can be shifted, invarious embodiments. Based on the mesial-distal placements of the firstrepositioning jaw element 706-2 and the second repositioning jaw element708-2 of the second treatment stage, the patient's jaw can berepositioned to a second incremental position and/or distance.

Although the present embodiments of FIGS. 7A-7D illustrate two treatmentstages of a treatment plan, embodiments in accordance with the presentdisclosure are not so limited. Treatment plans can include a variety ofnumber of treatment stages, including more or less than two treatmentstages. At least a portion of the treatment stages can include treatmentfor gradual advancement of the patient's jaw. Further, one or more ofthe treatment stages may not include repositioning jaw elements, invarious embodiments.

FIGS. 8A-8D illustrate examples of repositioning jaw elements accordingto a number of embodiments of the present disclosure. FIG. 8Aillustrates, for instance, repositioning jaw elements 806, 808, 810, 812that include geometric features 851-1, 851-2, 851-3, 851-4 to engagewith a repositioning jaw element on an opposing jaw.

Geometric features 851-1 . . . 851-4, as used herein, can include avariety of protruding geometric shapes (e.g., cylinder, rectangular,etc.) and/or receding geometric shapes (e.g., negative space thatmatches the protruding geometric shape on a repositioning jaw element onan opposing jaw). For example, a geometric feature 851-1 on the firstsurface of the first repositioning jaw element 806 of a first shell 814can include a concave shaped feature and a geometric feature 851-2 onthe second surface of the second repositioning jaw element 808 of asecond shell 816 can include a convex shaped feature shaped to mate withthe geometric feature 851-1 on the first surface of the firstrepositioning jaw element 806.

Similarly, a geometric feature 851-3 on the third surface of the thirdrepositioning jaw element 810 of the first shell 814 can include aconcave shaped feature and a geometric feature 851-4 on the fourthsurface of the fourth repositioning jaw element 812 of the second shell816 can include a convex shaped feature shaped to mate with thegeometric feature 851-3 on the third surface of the third repositioningjaw element 810.

FIG. 8B illustrates a repositioning jaw element 803 on an occlusalsurface of a removable dental appliance. As illustrated, therepositioning jaw element 803 can be located on an occlusal surface of afirst shell 814 (e.g., an upper dentition).

The repositioning jaw element 803 can, for instance, include an occlusalsurface that has a geometry shaped to mate with the contours of theocclusal surfaces of the second shell 816. The mating can, for instance,be designed to reposition the jaw of the patient by guiding the lowerjaw of the patient into a forward position or backward position (e.g.,to move sagittally).

FIGS. 8C-8D illustrate example of repositioning jaw elements 806, 808with magnets within. Repositioning jaw elements 806, 808 with magnetswithin can extend from occlusal, buccal, and/or lingual surfaces ofshells 814, 816 of a removable dental appliance. The magnets within therepositioning jaw elements 806, 808 on opposing jaws can be oppositepoles and/or same poles to guide the lower jaw to a position. Forexample, opposite poles on magnets can be used to attract the lower jawinto the forward position and/or same poles on magnets can be used topush the lower jaw into the forward position.

FIG. 8C illustrates an example of repositioning jaw elements 806, 808with magnets within that have opposite poles on opposite jaws to attractthe lower jaw (e.g., the second shell 816) into the forward position. Incontrast, FIG. 8D illustrates an example of repositioning jaw elements806, 808 with magnets within that have same poles on opposite jaws topush the lower jaw (e.g., the second shell 816) into the forwardposition.

Although the embodiments of FIGS. 8C and 8D illustrate attracting orpushing the lower jaw into a forward position (e.g., Class IIcorrection), embodiments in accordance with the present disclosure arenot so limited. For example, embodiments in accordance with the presentdisclosure can include magnets within repositioning jaw elements thatattract or push the lower jaw into a backward position (e.g., Class IIIcorrection).

FIGS. 9A-9B illustrate examples of features of devices for repositioningjaws according to a number of embodiments of the present disclosure. Thedevices illustrated in FIGS. 9A-9C can include removable dentalappliances. FIG. 9A, for instance, illustrates an example repositioningjaw element 907 with a groove 953 on a first shell 914 and a geometricfeature 909 on a second shell 916.

The groove 953 of the repositioning jaw element 907 can include, forinstance, a hollow channel located within and/or on a surface of therepositioning jaw element 907 that is angled (e.g., a surface of therepositioning jaw element 907 that is designed to interface, interact,and/or engage with another repositioning jaw element and/or shell). Thegroove 953 can be shaped to mate with a geometric feature 909 on asecond shell 916 on an opposite jaw. The geometric feature 909 on thesecond shell 916 on the opposite jaw can include a cylinder shapedfeature that can rotate and/or slide down the angled surface of therepositioning jaw element 907 of the first shell 914 until the groove953 is reached. That is, the groove 953 can limit and/or stop movementof the geometric feature 909 on the second shell 916. The groove 953 andgeometric feature 909 combination can, for instance, allow for greaterfreedom of motion of the lower jaw while repositioning the lower jaw toa forward position or backward position.

In some embodiments, a first repositioning jaw element of a first shell914 and a second repositioning jaw element of a second shell 916 caninclude geometric features. For instance, geometric features of a firstrepositioning jaw element and/or a second repositioning jaw element caninclude a protrusion and a socket. For example, a first repositioningjaw element can include a protrusion extending from the firstrepositioning jaw element in a direction toward occlusal surfaces teethof the opposing jaw. The second repositioning jaw element can include asocket within the second repositioning jaw element. The protrusion ofthe first repositioning jaw element can fit into the socket of thesecond repositioning jaw element to assist in guiding the lower jaw intoa forward position or a backward position.

FIG. 9B illustrates an example of a device with a first geometricfeature 911 on a first shell 914 and a second geometric feature 913 on asecond shell 916. For instance, the second geometric feature 913 caninclude a spring feature positioned on the second shell 916 and thefirst geometric feature 911 can include a tab feature positioned on thefirst shell 914 to interface, interact, and/or engage with the springfeature (e.g., the second geometric feature 913). The spring featurecan, for instance, guide the lower jaw of the patient to a forwardposition or backward position, for example. For instance, the firstgeometric feature 911 interfacing, interaction, and/or engaging with thesecond geometric feature 913 can provide a force on the lower jaw of thepatient to move sagittally the position of the lower jaw.

FIGS. 10A-10C illustrate examples of occlusal features of devices forrepositioning jaws according to a number of embodiments of the presentdisclosure. The devices illustrated in FIGS. 10A-10C can includeremovable dental appliances.

FIG. 10A illustrates an example device with a plurality of ridges on theocclusal surfaces of the first shell 1014 and a plurality of ridges onthe second shell 1016. The ridges can be used to guide the lower jaw ofthe patient to a position, such as a forward position or a backwardposition. Ridges, as used herein, can include protrusions that extend ina coronal-apical direction and have a buccal-lingual width (e.g., 1 mm).The ridges on the first shell 1014 can protrude in an alternating orderas the ridges on the second shell 1016, for instance.

FIG. 10B illustrates an example of a device with a plurality of pairs ofmagnets within the occlusal surface of the first shell 1014 and thesecond shell 1016. The magnets within the occlusal surfaces of theshells 1014, 1016 on opposing jaws can be opposite poles and/or samepoles to guide the lower jaw to a forward position or backward position.The plurality of pairs of magnets can be used to distribute the forceevenly across the arch and/or across posterior teeth.

FIG. 10C illustrates an example of a device with occlusal surfaces thathave a geometry that differs from the contours of occlusal surfaces ofteeth that are on an opposing jaw of the patient. For instance, thegeometry of the occlusal surface of the first shell 1014 and thegeometry of the occlusal surface of the second shell 1016 can include apattern to match a forward lower or backward lower jaw position of thepatient. As illustrated by FIG. 10C, in some embodiments, the geometrycan be on occlusal surfaces of a device that does not includerepositioning jaw elements and the geometry can retrain the muscles ofthe lower jaw to be positioned in a forward lower jaw position or abackward lower jaw position (e.g., to move sagittally).

Further, in various embodiments, a dental appliance of the presentdisclosure can include one or more repositioning jaw elements having astructure to indicate to a patient that the patient has positioned thefirst and second repositioning jaw elements of the first shell andsecond shell in a fully engaged sagittal jaw position. For example, inthe embodiment of FIG. 10C, the points of the repositioning jawstructure 1016 will stop when they fully engage with the cooperatingvalleys of the opposing repositioning jaw structure 1014. Other examplesof these indicting type structures can be seen in various embodimentsillustrated in the figures such as, FIGS. 8A, 8B, and 12B.

FIGS. 11A-11B illustrate examples of devices for repositioning jawsaccording to a number of embodiments of the present disclosure. Thedevices illustrated in FIGS. 11A-11B can include removable dentalappliances.

In a number of examples, a variety of features can be used in additionto and/or in place of repositioning jaw elements to guide the lower jawto a position, such as a forward position or a backward position.Example features can include connecting the first shell and the secondshell using material at the sides of the shells in the posterior region,a rigid or flexible connecting structure (e.g., as illustrated by FIGS.11A and 11B), ridges (e.g., as illustrated by FIG. 10A), magnets (e.g.,as illustrated by FIG. 10B), and/or occlusal surfaces (e.g., asillustrated by FIG. 10C), among other features.

FIG. 11A illustrates an example of a device with a first shell 1114 anda second shell 1116 connected by a rigid or flexible connectingstructure 1121 to advance a lower jaw of the patient to a position, suchas a forward position or backward position (e.g., move a lower jaw ofthe patient or opening up the bite to a desired range of jaw openingextending from the current position of occlusion). The rigid or flexibleconnecting structure 1121 can form a hinge.

The rigid or flexible connecting structure 1121 can include a strip ofmaterial (e.g., an arm), such as metal, polymer, and/or other material,which can connect the first shell 1114 to the second shell 1116. Asillustrated by the embodiment of FIG. 11A, the rigid structure 1121 canbe connected to the first shell 1114 and the second shell 1116 in avariety of ways. In some embodiments, the rigid or flexible connectingstructure 1121 can be connected to the first shell 1114 and the secondshell 1116 using magnetic materials 1123-1, 1123-2, pins 1125-1, 1125,and/or similar features.

These features can allow the connecting structure to be easily installedand removed by the patient. For instance, the rigid or flexibleconnecting structure 1121 can form a hinge that uses magnetic materials1123-1, 1123-2, pins 1125-1, 1125, and/or similar features to hold thefirst shell 1114 and the second shell 116 together while allowing thefirst shell 1114 and the second shell 116 to rotate. When a patientplaces the first shell 1114 and the second shell 1116 over their teeth,the patient can place the rigid or flexible connecting structure 1121near the appropriate location. The magnetic materials 1123-1, 1123-2, insome embodiments, can snap the rigid or flexible connecting structure1121 into the appropriate location (e.g., from a close and/or nearappropriate location to the appropriate location). A wire can be placedon a lingual surface of the second shell 1116 (e.g., lower jaw) todistribute the load evening across the dental arch, in variousembodiments.

FIG. 11B illustrates an example of a device with a first shell 1114 anda second shell 1116 formed as a single piece. The first shell 1114(e.g., upper jaw) and the second shell 1116 (e.g., lower jaw) can beconnected into one piece to advance a lower jaw of the patient oropening up the bite to a desired range of jaw opening extending from thecurrent position of occlusion. For example, the first shell 1114 and thesecond shell 1116 can be connected by material 1129 at a right posteriorside and a left posterior side of the first shell 1114 and the secondshell 1116. The material 1129 can include the same and/or differentmaterial than the material of the first shell 1114 and the second shell1116, for instance. The material 1129 can be flexible to allow jawarticulation while continuing to provide positioning guidance to thejaws.

FIGS. 12A-12B illustrate examples of devices according to a number ofembodiments of the present disclosure. The repositioning jaw elements1206, 1208 of the devices illustrated in FIGS. 12A-12B can interface,interact, and/or engage with one another to move a position of apatient's jaw from a current position of occlusion to a target and/orfinal position of occlusion (e.g., to move sagittally).

FIG. 12A illustrates an example of a device with a first repositioningjaw element 1206 extending from a surface of a first shell 1214 and asecond repositioning jaw element 1208 extending from a surface of asecond shell 1216. The first repositioning jaw element 1206 and thesecond repositioning jaw element 1208 can interface, interact, and/orengage in the presence of fully engaged sagittal jaw position of apatient.

As illustrated by the embodiment of FIG. 12A, in a number ofembodiments, one or more of the repositioning jaw elements 1206, 1208can include a layer of compressible material 1231-1, 1231-2 on a surfacedesigned to interface, interact, and/or engage with anotherrepositioning jaw element. For example, the compressible material1231-1, 1231-2 can assist in guiding the lower jaw of a patient to aforward or backward position by being in a compressed state when thesurfaces are initially interfacing, interacting, and/or engaged, thenuncompressing to push the lower jaw forward or backward as the jawsrelax. That is, the compressible material 1231-1, 1231-2 can becompressed when the jaws of the patient initially move to a fullyengaged sagittal jaw position and, as the patient's jaws relax over aperiod of time, the compressive material 1231-1, 1231-2 can expand(e.g., increase in thickness from the compressed state) to push thelower jaw forward or backward.

FIG. 12B illustrates an example of a device with a first repositioningjaw element 1206 extending from a surface of a first shell 1214 and asecond repositioning jaw element 1208 extending from a surface of asecond shell 1216. In some embodiments, at least one of therepositioning jaw elements (e.g., the first repositioning jaw element1206 and the second repositioning jaw element 1208) can include occlusalsurfaces that substantially follow the contours of the occlusal surfacesof teeth on an opposing jaw of the patient.

For instance, as illustrated by the embodiment of FIG. 12B, the occlusalsurface (e.g., the top surface) of the first repositioning jaw element1206 can substantially follow the contours of the occlusal surfaces ofthe posterior teeth of the lower jaw (e.g., the occlusal surfaces of theposterior teeth of the lower jaw that the first repositioning jawelement 1206 may contact). The occlusal surface of the secondrepositioning jaw element 1208 can substantially follow the contours ofthe occlusal surfaces of the posterior teeth of the upper jaw (e.g., theocclusal surfaces of posterior teeth of the upper jaw that the secondrepositioning jaw element 1208 may contact). Shaping the occlusalsurfaces of repositioning jaw elements based on the patient's dentitionmay, for instance, avoid interference between cusps of teeth that mayotherwise hit interferences in an opposing jaw which could increase thelikelihood of unwanted tooth and/or jaw movements.

FIGS. 12C-12D illustrate examples of repositioning jaw elements 1206,1208 according to a number of embodiments of the present disclosure. Theupper jaw 1202, the first repositioning jaw element 1206, the lower jaw1204, and the second repositioning jaw element 1208 illustrated in FIGS.12C-12D can include virtual images of jaws and repositioning jawelements, respectively (e.g., virtual jaws and/or virtual repositioningjaw elements), and/or a physical mold. The virtual images and/orphysical mold of the jaws 1202, 1204 and repositioning jaw elements1206, 1208 can be used to determine a treatment plan for the patientand/or to form a physical dental appliance and/or physical repositioningjaw element.

FIG. 12C illustrates a side view of an upper jaw 1202 with a firstrepositioning jaw element 1206 and a lower jaw 1204 with a secondrepositioning jaw element 1208 according to a number of embodiments ofthe present disclosure. In a number of embodiments, one or moreattachment elements 1233-1, 1233-2, 1233-3, 1233-4, 1233-5 can bevirtually and/or physically attached to a surface of at least some ofthe virtual teeth, set of molded teeth, and/or physical teeth of apatient. The attachment elements 1233-1 . . . 1233-5 can be used tominimize and/or prevent degrading the retention and/or functionality ofthe shell of the dental appliance.

For instance, the attachment elements 1233-1 . . . 1233-5 can be addeddirectly to a buccal/facial and/or lingual surface of a patient's tooth.An attachment element, as used herein, can include an attachmentsub-device with a small base extending across a mesial-distal and/orincisal-gingival-crown surface of the tooth. The attachment elements1233-1 . . . 1233-5 can be bonded to any surface of the tooth (and bemade either indirectly (e.g. a light or chemical-cured dental composite)or directly (e.g. prefabricated plastic, composite, or porcelainobject)). An attachment element bonded to a lingual surface of a toothof the patient can be more aesthetically pleasing to a patient (and lessnoticeable to others than an attachment element bonded to abuccal/facial surface). The attachment elements 1233-1 . . . 1233-5 canalso be attached to at least some of the anchoring teeth. The attachmentelements 1233-1 . . . 1233-5 can include a variety of geometric shapes,such as ovoid, tear-drop, ramp, hexagonal, and/or rectangular, amongother shapes.

The one or more attachment elements 1233-1 . . . 1233-5 can be designedto work with a virtual model of a removable dental appliance and/or aphysical removable dental appliance. The shell can be shaped, forinstance, to be placed over the attachment element(s) 1233-1 . . .1233-5 to minimize and/or prevent vertical displacement of the shell.For example, the shell can include a ridge on the shell used to retainthe dental appliance on the teeth. The attachment elements 1233-1 . . .1233-5 can, for instance, provide friction between the dental applianceand the teeth to increase retention of the dental appliance. That is,the attachment elements 1233-1 . . . 1233-5 can create greater retentionof the dental appliance in a particular direction.

FIG. 12D illustrates a front view of an upper jaw 1202 with a firstrepositioning jaw element 1206 and a third repositioning jaw element1210 and a lower jaw 1204 with a second repositioning jaw element 1208and a fourth repositioning jaw element 1212 according to a number ofembodiments of the present disclosure.

In various embodiments, at least one of the repositioning jaw elements1206, 1208, 1210, 1212 can be shaped to minimize and/or preventdegrading the retention and/or functionality of the shell of the dentalappliance. For example, as illustrated in the embodiment of FIG. 12D,the buccal-lingual width of a repositioning jaw element (e.g., therepositioning jaw elements 1206, 1208, 1210, 1212) can be different onan occlusal surface of the repositioning jaw element (e.g., top surface)than on a buccal-lingual width of a surface of the repositioning jawelement adjacent to the shell (e.g., bottom surface). That is, the sidesurfaces of the repositioning jaw elements can be tapered inward towardthe bottom surface. For instance, the buccal-lingual width of arepositioning jaw element can be wider on an occlusal surface of therepositioning jaw element than on a buccal-lingual width of a surface ofthe repositioning jaw element adjacent to the shell. Such a shape can besimilar to the construction of an I-beam with the wider buccal-lingualocclusal surface interfacing with an occlusal surface of a repositioningjaw element positioned on an opposing jaw.

FIGS. 13A-13B illustrate examples of side surface features according toa number of embodiments of the present disclosure. The side surfacefeatures and jaws illustrated in FIGS. 13A-13B can include virtual sidesurface features and virtual jaws of a patient or physical molds of apatient's jaws with side surface features, in some embodiments.

A side surface feature, as used herein, can extend beyond the occlusalplane of a removable dental appliance to engage with buccal and lingualcoronal side surfaces of at least one tooth and/or a removable dentalappliance on the opposite jaw of the patient. The side surface featurescan, for instance, add retention to molar teeth to balance movementcreated by the repositioning jaw elements and/or prevent and/or limit aposterior surface of the removable dental appliance from contactingmolars. That is, although not illustrated by the embodiments of FIGS.13A-13B, the side surface features can be used in addition torepositioning jaw elements, such as repositioning jaw elements 106, 108illustrated in FIG. 1A.

FIG. 13A illustrates posterior view of an upper jaw 1302 and a lower jaw1304 with a number of side surface features 1335-1, 1335-2, 1337-1,1337-2, 1337-3 according to a number of embodiments of the presentdisclosure. As illustrated by FIG. 13A, the number of side surfacefeatures can include buccal side surface features 1335-1, 1335-2 andlingual side surface features 1337-1, 1337-2, 1337-3.

FIG. 13B illustrates a view of a posterior side of the upper jaw 1302and the lower jaw 1304 with the number of side surface features 1335-1,1335-2, 1337-1, 1337-2. The upper jaw 1302, the lower jaw 1304, and thenumber of side surface features 1335-1, 1335-2, 1337-1, 1337-2illustrated in FIG. 13B can include the same or different jaws and sidesurface features as illustrated in FIG. 13A, in various embodiments.

The side surface features 1335-1, 1335-2, 1337-1, 1337-2, as illustratedby FIG. 13B, can include a pair of side surface features (e.g., a firstbuccal side surface feature 1335-1 and a first lingual side surfacefeature 1337-1) on the first posterior side of the upper jaw 1302 and apair of side surface features (e.g., a second buccal side surfacefeature 1335-2 and a second lingual side surface feature 1337-2) on thesecond posterior side of lower jaw 1304. Each pair of side surfacefeatures (e.g., the first buccal side surface feature 1335-1 and thefirst lingual side surface feature 1337-1) can engage with side surfacesof at least one tooth and/or a removable dental appliance on theopposite jaw of the patient.

FIGS. 14A-14B illustrate examples of repositioning jaw elements foradjusting a midline of a patient according to a number of embodiments ofthe present disclosure. The repositioning jaw elements and jawsillustrated in FIGS. 14A-14B can include virtual repositioning jawelements and virtual jaws of a patient or physical molds of a patient'sjaws with repositioning jaw elements, for instance.

In accordance with a number of embodiments of the present disclosure,the repositioning jaw elements can be used to adjust a midline of apatient. A midline of a patient, as used herein, can include amidsagittal line of the teeth of the upper jaw and the teeth of thelower jaw of the patient.

For instance, repositioning jaw elements can be placed on the right andleft posterior side of a shell for the upper jaw and the right and leftposterior side of a shell for the lower jaw. The surfaces ofrepositioning jaw elements on the shell of each jaw that are designed tointerface, interact, and/or engage surfaces of repositioning jawelements on an opposing jaw can be angled at the same angle and/oropposite angles, in various instances. For example, for minor adjustmentto the midline of a patient, the surfaces of repositioning jaw elementson the shell of a jaw (e.g., upper or lower) can be angled at opposingangles. In contrast, for larger adjustments to the midline of thepatient, the surfaces of repositioning jaw elements (e.g., the right andleft posterior side) on the shell of a jaw (e.g., upper or lower) can beangled at the same angle.

FIG. 14A illustrates an example of a side view of an upper jaw 1402 witha first repositioning jaw element 1406 and a third repositioning jawelement 1410 and a lower jaw 1404 with a second repositioning jawelement 1408 and a fourth repositioning jaw element 1412. The firstrepositioning jaw element 1406 and second repositioning jaw element1408, and the third repositioning jaw element 1410 and the fourthrepositioning jaw element 1412, respectively, can be designed tointerface, interface, and/or engage in the present of a fully engagedsagittal jaw position to guide the lower jaw 1404 of the patient in amesial-distal direction.

In various embodiments, the guidance of the lower jaw 1404 in amesial-distal direction can be concurrent with guiding the lower jaw1404 in a forward or backward direction (e.g., anterior-posteriordirection). That is, the midline of the patient can be adjustedconcurrently with adjusting the sagittal jaw position of the patientusing the repositioning jaw elements 1406, 1408, 1410, 1412.

FIG. 14B illustrates an example of a view of an upper jaw 1402 with afirst repositioning jaw element 1406 and a third repositioning jawelement 1410 and a lower jaw 1404 with a second repositioning jawelement 1408 and a fourth repositioning jaw element 1404. The jaws 1402,1404 and repositioning jaw elements 1406, 1408, 1410, 1412 illustratedin FIG. 14B can include the same or different jaws/repositioning jawelements as illustrated in FIG. 14A, in various embodiments.

As illustrated by the embodiment of FIG. 14B, in a number ofembodiments, the surfaces of the repositioning jaw elements (e.g., theright and left posterior side) on the shell of a jaw (e.g., upper orlower) can be angled at the same angle. For instance, the firstrepositioning element 1406 and the third repositioning jaw element 1410of the first jaw 1402 are angled at the same angle (e.g., a firstangle). Similarly, the second repositioning jaw element 1408 and thefourth repositioning jaw element 1412 are angled at the same angle(e.g., a second angle), which can be an opposite angle as the firstrepositioning jaw element 1406 and the third repositioning jaw element1410. However, embodiments in accordance with the present disclosure arenot so limited. For instance, the surfaces of repositioning jaw elementson the shell of a jaw (e.g., upper or lower) can be angled at opposingangles, in a number of embodiments.

Further, the embodiments illustrated by FIGS. 14A-14B can includerepositioning jaw elements 1406, 1408, 1410, 1412 that adjust themidline of a patient toward the patient's right side. However,embodiments in accordance with the present disclosure are not so limitedand can include repositioning jaw elements designed to adjust themidline of a patient toward the patient's left side.

Listing of Exemplary Embodiments:

A. A removable dental appliance comprising:

-   -   a. a first shell having a number of tooth apertures configured        to receive and reposition a number of teeth of a patient's upper        dentition;    -   b. a second shell having a number of tooth apertures configured        to receive and reposition a number of teeth of the patient's        lower dentition;    -   c. a first repositioning jaw element that extends from a surface        of the first shell and includes a first surface;    -   d. a second repositioning jaw element that extends from a        surface of the second shell and includes a second surface to        interface with the first surface of the first repositioning jaw        element;    -   e. wherein the first repositioning jaw element and the second        repositioning jaw element are positioned to interface in a        presence of a fully engaged sagittal jaw position of the        patient's upper dentition and the patient's lower dentition in a        manner to reposition the patient's jaw; and    -   f. wherein the removable dental appliance is configured to        reposition the number of teeth of the patient's upper dentition        and the number of teeth of the patient's lower dentition        concurrently with the repositioning of the patient's jaw.

B. The removable dental appliance of claim A, wherein at least one ofthe first repositioning jaw element and the second repositioning jawelement are positioned to generate distalizing force on at least some ofthe teeth within.

C. The removable dental appliance of claim A, wherein:

-   -   a. the first repositioning jaw element includes a first        geometric feature; and    -   b. the second repositioning jaw element includes a second        geometric feature shaped to mate with the first geometric        feature.

D. The removable dental appliance of claim C, wherein the firstgeometric feature includes a protrusion and the second geometric featureincludes a socket.

E. The removable dental appliance of claim A, wherein at least one ofthe first repositioning jaw element and the second repositioning jawelement include a layer of compressible material on a surface.

F. The removable dental appliance of claim A, wherein at least one ofthe first surface and the second surface are angled to adjust a midlineof patient.

G. The removable dental appliance of claim A, wherein the firstrepositioning jaw element and the second repositioning jaw elementsinclude occlusal surfaces to follow contours of occlusal surfaces ofteeth on an opposing jaw.

H. The removable dental appliance of claim A, wherein at least one ofthe first repositioning jaw element and the second repositioning jawelement include side surface features that extend beyond the occlusalplane of the removable dental appliance to engage with at least one of abuccal and a lingual side surfaces of a shell of an opposite jaw.

I. The removable dental appliance of claim A, wherein the firstrepositioning jaw element and the second repositioning jaw element arepositioned near at least one of an unerupted and a removed molar toothof the patient.

J. The removable dental appliance of claim A, wherein the first shelland the second shell include a plurality of repositioning jaw elementsextending from at least one of a buccal and lingual surface of the firstshell and the second shell.

K. The removable dental appliance of claim A, wherein the firstrepositioning jaw element and the second repositioning jaw elementinclude at least a magnet within to interact and guide the lower jawinto a position.

L. The removable dental appliance of claim A, wherein at least one ofthe first repositioning jaw element and the second repositioning jawelement includes a top surface with a wider buccal-lingual width than abuccal-lingual width of a bottom surface.

M. A removable dental appliance comprising:

-   -   a. a first shell having a number of tooth apertures configured        to receive and reposition a number of teeth of a patient's upper        dentition;    -   b. a second shell having a number of tooth apertures configured        to receive and reposition a number of teeth of the patient's        lower dentition;    -   c. wherein the first shell and the second shell interface in a        presence of a fully engaged sagittal jaw position of the        patient's upper dentition and the patient's lower dentition in a        manner to reposition the patient's jaw; and    -   d. wherein the removable dental appliance is configured to        reposition the number of teeth of the patient's upper dentition        and the number of teeth of the patient's lower dentition        concurrently with the repositioning of the patient's jaw.

N. The removable dental appliance of claim M, wherein:

-   -   a. the first shell includes a protrusion; and    -   b. the second shell includes a socket shaped to mate with the        protrusion to move a lower jaw of the patient from an        articulation path of opening to a desired range of jaw opening        extending from a current occluding position.

O. The removable dental appliance of claim M, wherein the first shelland the second shell include occlusal surfaces with a geometry thatdiffers from the contours of the occlusal surfaces of the teeth of anopposing jaw.

P. The removable dental appliance of claim M, wherein:

-   -   a. the first shell includes a spring; and    -   b. the second shell includes a tab to interact with the spring.

Q. The removable dental appliance of claim M, wherein the first shelland the second shell each include a plurality of ridges on occlusalsurfaces to guide the jaw into a position.

R. The removable dental appliance of claim M, wherein the first shelland the second shell include pairs of magnets within occlusal surfacesof the first shell and the second shell to interact and guide the jaw ofthe patient into a position.

S. The removable dental appliance of claim M, wherein occlusal surfacesof the first shell and the second shell include a geometry to match ajaw position.

T. The removable dental appliance of claim M, wherein the first shelland the second shell are connected by a rigid or flexible connectingstructure to move a lower jaw into a position.

U. The removable dental appliance of claim M, wherein the first shelland the second shell are connected by material at a right posterior sideand a left posterior side of the first shell and the second shell.

V. The removable dental appliance of claim M, wherein:

-   -   a. the first shell includes a repositioning jaw element with a        groove; and    -   b. the second shell includes a geometric feature to interact        with the groove.

Although specific embodiments have been illustrated and describedherein, those of ordinary skill in the art will appreciate that anyarrangement calculated to achieve the same techniques can be substitutedfor the specific embodiments shown. This disclosure is intended to coverany and all adaptations or variations of various embodiments of thedisclosure.

It is to be understood that the above description has been made in anillustrative fashion, and not a restrictive one. Combination of theabove embodiments, and other embodiments not specifically describedherein will be apparent to those of skill in the art upon reviewing theabove description. The scope of the various embodiments of thedisclosure includes any other applications in which the above structuresand methods are used. Therefore, the scope of various embodiments of thedisclosure should be determined with reference to the appended claims,along with the full range of equivalents to which such claims areentitled.

In the foregoing Detailed Description, various features are groupedtogether in example embodiments illustrated in the figures for thepurpose of streamlining the disclosure. This method of disclosure is notto be interpreted as reflecting an intention that the embodiments of thedisclosure require more features than are expressly recited in eachclaim.

Rather, as the following claims reflect, inventive subject matter liesin less than all features of a single disclosed embodiment. Thus, thefollowing claims are hereby incorporated into the Detailed Description,with each claim standing on its own as a separate embodiment.

What is claimed is:
 1. A non-transitory computing device readable mediumstoring instructions executable by a processor to cause a computingdevice to perform a method, comprising: identifying a misaligned jaw ofa patient from a virtual image of the patient's jaw; providing atreatment plan for the patient comprising a plurality of stages, eachstage of the plurality of stages including a virtual model of a dentalappliance having a first shell and a second shell configured toreposition at least one tooth of the patient, the virtual model of thedental appliance including repositioning jaw elements on the first shelland the second shell configured to move a position of the misaligned jawof the patient; virtually testing movement of the jaw and movement ofthe at least one tooth to occur by the patient wearing the dentalappliances for each of the plurality of stages of the treatment plan;and adjusting positions of the virtual repositioning jaw elements withrespect to the first shell and the second shell in incremental distancesin response to changes in position of the patient's jaw from an initialjaw position to subsequent positions and movement of the at least onetooth from an initial tooth position to subsequent tooth positionsassociated with the plurality of stages of the treatment plan, eachsubsequent position determined based on a positions the jaw and of theat least one tooth in a previous step of the treatment plan and thevirtual testing of the movement of the jaw and the at least one tooth inthe previous step of the treatment plan.
 2. The non-transitory computingdevice readable medium of claim 1, wherein providing the treatment planfurther includes: identifying a final jaw position of the patient; anddesigning the repositioning jaw elements to move the position of themisaligned jaw of the patient toward the final jaw position.
 3. Thenon-transitory computing device readable medium of claim 1, whereinidentifying the misaligned jaw of the patient includes determining adegree of the patient's jaw alignment utilizing the virtual image of thepatient's jaw.
 4. The non-transitory computing device readable medium ofclaim 1, wherein providing the treatment plan further includes:providing a virtual model of a plurality of dental appliances, includingthe dental appliance; and wherein the plurality of dental appliances isconfigured to reposition the misaligned jaw in incremental distancesaccording to the plurality of stages of a treatment plan.
 5. Thenon-transitory computing device readable medium of claim 1, wherein therepositioning jaw elements on the first shell and the second shell aredesigned based on an aim of repositioning the misaligned jaw of thepatient.
 6. A non-transitory computing device readable medium storinginstructions executable by a processor to cause a computing device toperform a method, comprising: providing a treatment plan for a patientincluding a virtual model of a dental appliance having a shellconfigured to reposition a plurality of teeth of the patient;positioning a virtual repositioning jaw element configured to move aposition of a misaligned jaw of the patient on the shell of the virtualmodel of the dental appliance parallel to a bite plane of the patient,wherein the repositioning jaw element extends from a surface of theshell of the virtual model of the dental appliance; placing a groove ona surface of the virtual repositioning jaw element; virtually testingmovement of the jaw and movement of the at least one tooth to occur bythe patient wearing the dental appliances for each of the plurality ofstages of the treatment plan; and adjusting positions of the virtualrepositioning jaw elements with respect to the first shell and thesecond shell in incremental distances in response to changes in positionof the patient's jaw from an initial jaw position to subsequentpositions and movement of the at least one tooth from an initial toothposition to subsequent tooth positions associated with the plurality ofstages of the treatment plan, each subsequent position determined basedon positions of the jaw and of the at least one tooth in a previous stepof the treatment plan and the virtual testing of the movement of the jawand the at least one tooth in the previous step of the treatment plan.7. The non-transitory computing device readable medium of claim 6,wherein the instructions are executable to perform the method includingbeveling side surfaces of the virtual repositioning jaw element toinclude a different buccal-lingual width on a bottom surface than abuccal-lingual width on a top surface of the virtual repositioning jawelement.
 8. The non-transitory computing device readable medium of claim6, wherein the instructions are executable to perform the methodincluding curving a back surface of the virtual repositioning jawelement in a distal direction.
 9. The non-transitory computing devicereadable medium of claim 6, wherein the instructions are executable toperform the method including placing the groove on a top surface of thevirtual repositioning jaw element.
 10. The non-transitory computingdevice readable medium of claim 6, wherein the instructions areexecutable to perform the method including placing the groove on atleast one of a buccal side surface and a lingual side surface of thevirtual repositioning jaw element.
 11. The non-transitory computingdevice readable medium of claim 6, wherein the instructions are furtherexecutable to perform the method including curving side surfaces of thevirtual repositioning jaw element in at least one of a buccal directionand a lingual direction.
 12. A non-transitory computing device readablemedium storing instructions executable by a processor to cause acomputing device to perform a method, comprising: identifying amisaligned jaw of a patient from a virtual image of the patient's jaw;providing a treatment plan including a plurality of stages for thepatient including a virtual model of a dental appliance having a firstshell and a second shell configured to reposition at least one tooth ofthe patient, the virtual model of the dental appliance includingrepositioning jaw elements comprising shapes and angles specific to eachstage of the treatment plan on the first shell and the second shellconfigured to move a position of the misaligned jaw of the patient;virtually testing movement of the jaw and movement of the at least onetooth to occur by the patient wearing the dental appliances for each ofthe plurality of stages of the treatment plan; and adjusting positionsof the repositioning jaw elements with respect to the first shell andthe second shell in incremental distances in response to changes inposition of the patient's jaw from an initial jaw position to subsequentpositions associated with the plurality of stages of the treatment plan,each subsequent position determined based on positions of the jaw and ofthe at least one tooth in a previous step of the treatment plan and thevirtual testing of the movement of the jaw and the at least one tooth inthe previous step of the treatment plan, wherein the shapes and anglesspecific to each stage of the treatment plan on the first shell and thesecond shell differ in each subsequent step of the treatment plan. 13.The non-transitory computing device readable medium of claim 12, whereinproviding the treatment plan further includes: identifying a final jawposition of the patient.
 14. The non-transitory computing devicereadable medium of claim 12, wherein providing the treatment planfurther includes: identifying a final jaw position of the patient; anddesigning the repositioning jaw elements to move the position of themisaligned jaw of the patient toward the final jaw position.
 15. Thenon-transitory computing device readable medium of claim 12, whereinidentifying the misaligned jaw of the patient includes determining adegree of the patient's jaw alignment utilizing the virtual image of thepatient's jaw.
 16. The non-transitory computing device readable mediumof claim 12, wherein the instructions are executable to perform themethod including virtually testing the jaw movement to occur by thepatient wearing the dental appliance.
 17. The non-transitory computingdevice readable medium of claim 12, wherein providing the treatment planfurther includes: providing a virtual model of a plurality of dentalappliances, including the dental appliance; and wherein the plurality ofdental appliances is configured to reposition the misaligned jaw inincremental distances according to the plurality of stages of thetreatment plan.